Use of oxygenation, ventilation indices, and pulmonary hypertension as selection parameters for thoracoscopic repair of congenital diaphragmatic hernia, improved outcome: A retrospective study

Background: Many reports describing the thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) have been published in the last two decades. These showed the safety and feasibility of the technique. CDH TR was based on selection criteria relying on authors' experience. Many indices were described to determine preoperative evaluation and prognosis in CDH cases. Purpose: We aim to settle selection criteria to help in selecting CDH cases to improve the outcome of TR in limited resource centers plus usage of oxygenation and ventilation indices as predictors for the postoperative outcome. Patients and Methods: Between January 2016 and June 2023, 59 ventilated neonates with posterolateral CDH have been subjected to TR. Results: A total of 59 cases were included in the study divided into. Group A: Included 47 survivor patients. Group B: Included 12 nonsurvivor patients. The mean values for survivors; mean ventilation index (VI) was 474.75 +/- 114.01, mean oxygenation index (OI) was 7.95 +/- 2.01, and mean oxygenation saturation index (OSI) was 6.95 +/- 3.11. There was a correlation of VI, OI, and OSI with mortality where all dead cases have higher values where VI greater than 500, OI greater than 10, OSI greater than 10, and pulmonary hypertension less than 40 mmHg. Conclusion: TR of CDH is feasible and safe even in countries with limited infrastructure. The selection criteria for good outcomes are VI less than 500, OI less than 10, OSI less than 10, and pulmonary hypertension less than 40 mmHg added to the clinical patients' criteria and surgical expertise.