Thoracoscopic Patch Repair of Large Congenital Diaphragmatic Hernia Defects is Safe and Associated with Low Recurrence Rate.

BACKGROUND: Thoracoscopic patch repair of congenital diaphragmatic hernia (CDH) remains challenging for large defects, with no consensus on optimal patch fixation technique. This study evaluates outcomes of thoracoscopic patch repair stratified by defect size and suturing technique and compares them with primary thoracoscopic repair. METHODS: A retrospective review was performed of CDH patients undergoing thoracoscopic repair at a single tertiary centre (2019-2025). Primary outcomes were operative time and recurrence, stratified by defect size and suturing technique (interrupted vs. running), with secondary comparison with primary thoracoscopic repair. RESULTS: Of 63 patients undergoing thoracoscopic CDH repair, 46(73%) had patch repair; 39(61.9%) were completed thoracoscopically (conversion rate 11.1%). Among patients receiving a patch 69.2%(27/39) had type C or D defects. Mean operative time was 154.4±33.5 minutes. Type D defects were associated with significantly longer operative times than type B (189±25 vs. 142±24 minutes; p = 0.03). Recurrence occurred in 3/39(7.7%) patients at a mean follow-up of 17 months; no significant association with defect size was identified (p > 0.99). Suturing technique did not significantly influence operative time (interrupted vs. running: 164±33 vs.153 ± 33 minutes; p = 0.39) or recurrence (1.4%vs.3.8% at quadrant-level analysis; p > 0.05). Recurrence rates were comparable between thoracoscopic patch and primary repair groups (7.7%vs.5.9%; p > 0.99). CONCLUSIONS: Thoracoscopic patch repair of large CDH defects is feasible. Operative times and recurrence rate were comparable between suturing techniques. Larger multicentre studies are needed to validate these findings.