Adaptability of minimally invasive thoracoscopic repair for congenital diaphragmatic hernia: a neonatal case report from a low-income country.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a rare but potentially life-threatening congenital anomaly characterized by herniation of abdominal organs into the thoracic cavity, resulting in respiratory compromise and pulmonary hypoplasia. CASE PRESENTATION: A 2-day-old female neonate weighing 2.5 kg presented with severe respiratory distress, cyanosis, and a scaphoid abdomen. Chest radiography and computed tomography revealed a large left-sided Bochdalek hernia containing the stomach, spleen, left kidney, and bowel loops, causing compression of the left lung and mediastinal shift. After stabilization with mechanical ventilation, the patient underwent thoracoscopic repair. The patient was positioned in the right lateral decubitus position, and three 5-mm ports were inserted. Carbon dioxide insufflation was maintained at 5 mmHg with a flow rate of 1 L/min. The herniated viscera were reduced, and a 5 × 5 cm diaphragmatic defect was closed primarily with interrupted 3-0 polypropylene sutures, without mesh reinforcement. The operative time from skin incision to wound closure was 35 minutes. The postoperative course was uneventful, with extubation on the first postoperative day and discharge on the fourth postoperative day. No recurrence was observed over 1 year of follow-up. CONCLUSION: This case demonstrates the feasibility of thoracoscopic primary repair of CDH in a carefully selected neonate within a resource-limited setting, resulting in favorable short- and long-term outcomes.