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A newborn baby boy (42 weeks' gestation with good start, Apgar scores 9,10) developed intermittent grunting with slight subcostal retractions in the first hours after birth. At first heart sounds were audible on the left side, but within two hours these shifted to the right side of the chest. The baby's colour changed from pink to pale. A chest x ray (fig 11)) showed a left diaphragmatic hernia with displacement of the heart to the right side due to intestinal loops in the left thorax. A thoracoscopy was carried out. There was a small defect in the left posterolateral diaphragm, which was closed primarily without a patch (figs 22 and 3). The baby was rapidly extubated and oral feeding started. A chest x ray taken on the fourth postoperative day showed almost normal findings.
Diaphragmatic hernia has a spectrum of presentations, ranging from non‐symptomatic to a life‐threatening situation immediately after birth. Symptomatic hernias are treated by surgical closure of the posterolateral defect. With the advent of minimal invasive surgery, in patients with stable cardiorespiratory status, the defect may be closed through a laparoscopic or thoracoscopic approach with or without the use of a patch.1,2 In the present case the baby had an envelope‐like defect, which was suitable for primary closure. The case illustrates nicely the minimal invasive closure of the diaphragmatic hernia using a thoracoscopic approach.
Competing interests: None declared.