{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:01:59Z","timestamp":1760238119596,"version":"build-2065373602"},"reference-count":13,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Purpose: To describe a minimally invasive technique with primary closure and strong suture connection that is feasible in cases of larger, most common type B defects of congenital diaphragmatic hernia (CDH). Background: The thoracoscopic approach (TA) is a favorable technique for the repair of CDH and is still evolving globally. A common issue is finding the optimal suture technique for secure closure in order to prevent recurrences. Whether a defect can be closed only by sutures or by using a patch depends on the size of CDH, the presence of a muscular rim along the inner thoracic surface and finally on the surgeon\u2019s experience. From a geometrical point of view, the challenge is to transform the circular defect into a line, without tension, with a strong compound and preferably without additional material. To address this, we apply a setting of the sutures in a \u201cT-shape\u201d and a way to lead the sutures around the rib bones in order to increase stability. This method allows for the primary closure of CDHs and also applies to larger defects. Cases: We present seven newborns with posterolateral CDH on the left side. The defects were solely repaired by TA and by the suturing technique described in detail.<\/jats:p>","DOI":"10.3390\/children9081116","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T22:03:42Z","timestamp":1658873022000},"page":"1116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thoracoscopic Guided Pericostal Sutures as a Solid Fixation for Primary Closure of Congenital Diaphragmatic Hernias"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4071-1961","authenticated-orcid":false,"given":"Armin-Johannes","family":"Michel","sequence":"first","affiliation":[{"name":"Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"Metzger","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6737-4013","authenticated-orcid":false,"given":"Steven Alan","family":"Rice","sequence":"additional","affiliation":[{"name":"University Hospital for Children and Adolescents, Universit\u00e4tsmedizin Rostock, 18057 Rostock, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roman","family":"Metzger","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.earlhumdev.2014.09.013","article-title":"Congenital Diaphragmatic Hernia","volume":"90","author":"McHoney","year":"2014","journal-title":"Early Hum. Dev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F137","DOI":"10.1136\/archdischild-2014-306174","article-title":"Epidemiology of Congenital Diaphragmatic Hernia in Europe: A Register-Based Study","volume":"100","author":"McGivern","year":"2015","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"The Congenital Diaphragmatic Hernia Study Group (2007). Defect Size Determines Survival in Infants With Congenital Diaphragmatic Hernia. Pediatrics, 120, e651\u2013e657.","DOI":"10.1542\/peds.2006-3040"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.jpeds.2014.10.024","article-title":"Persistence of Pulmonary Hypertension by Echocardiography Predicts Short-Term Outcomes in Congenital Diaphragmatic Hernia","volume":"166","author":"Lusk","year":"2015","journal-title":"J. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jpedsurg.2017.03.011","article-title":"Factors Associated with Early Recurrence after Congenital Diaphragmatic Hernia Repair","volume":"52","author":"Putnam","year":"2017","journal-title":"J. Pediatr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1016\/j.jpedsurg.2013.08.014","article-title":"Standardized Reporting for Congenital Diaphragmatic Hernia\u2014An International Consensus","volume":"48","author":"Lally","year":"2013","journal-title":"J. Pediatr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.jpedsurg.2010.11.048","article-title":"Early Recurrence of Congenital Diaphragmatic Hernia Is Higher after Thoracoscopic than Open Repair: A Single Institutional Study","volume":"46","author":"Gander","year":"2011","journal-title":"J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2818","DOI":"10.1007\/s00464-015-4560-8","article-title":"Thoracoscopic versus Open Repair of CDH in Cardiovascular Stable Neonates","volume":"30","author":"Costerus","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"12661","DOI":"10.1038\/s41598-021-91908-7","article-title":"A Systematic Review and Meta-Analysis of Surgical Morbidity of Primary versus Patch Repaired Congenital Diaphragmatic Hernia Patients","volume":"11","author":"Heiwegen","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s10029-019-02003-w","article-title":"Simple and Safe Thoracoscopic Repair of Neonatal Congenital Diaphragmatic Hernia by a New Modified Knot-Tying Technique","volume":"23","author":"He","year":"2019","journal-title":"Hernia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1055\/s-0035-1568996","article-title":"Thoracoscopic Repair of Diaphragmatic Hernia in Infants: A New Modification of the Technique","volume":"26","author":"Li","year":"2015","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1055\/s-0037-1604049","article-title":"A Novel Technique of Posterolateral Suturing in Thoracoscopic Diaphragmatic Hernia Repair","volume":"5","author":"Boo","year":"2017","journal-title":"Eur. J. Pediatr. Surg. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"967","DOI":"10.17219\/acem\/122396","article-title":"The Application of the Percutaneous Suturing Technique in Thoracoscopic Repair of Congenital Diaphragmatic Hernia","volume":"29","author":"Bogusz","year":"2020","journal-title":"Adv. Clin. Exp. Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1116\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:56:37Z","timestamp":1760140597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,26]]},"references-count":13,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["children9081116"],"URL":"https:\/\/doi.org\/10.3390\/children9081116","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2022,7,26]]}}}