Comparative study between Extra-pleural versus Trans-pleural approaches in Surgical PDA Ligation in Pediatrics

Mohammed, Mohammed Abdelmoatty; Abdelateef, Mahmoud Khairy; Abdelrasheed, Ahmed Abdelmoneim; Ahmed, Mohamed Abdel Bary

doi:10.21608/svuijm.2024.236290.1763

Comparative study between Extra-pleural versus Trans-pleural approaches in Surgical PDA Ligation in Pediatrics

Document Type : Original research articles

Authors

¹ Department of Cardiothoracic Surgery, Faculty of Medicine, South Valley University, Qena, Egypt.

² Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.

³ Department of General and Pediatric Surgery, Faculty of Medicine, South Valley University, Qena, Egypt.

10.21608/svuijm.2024.236290.1763

Abstract

Background: Patent ductus arteriosus (PDA) is a common congenital heart defect, that can cause cardiorespiratory morbidity, and closure is crucial to prevent complications. New PDA surgical ligation techniques have evolved to improve outcomes and reduce hospital stays.
Objectives: To compare the outcome of the extra-pleural versus trans-pleural approaches in surgical PDA ligation.
Patients and methods: The study involves 40 PDA patients, divided into two groups: Group A (n=20) ligated via a trans-pleural approach and Group B (n=20) ligated via an extra-pleural approach. The study compares the operative time, intra-operative complications, hospital stays, and post-operative complications.
Results: PDA was successfully ligated in all cases except one case which needed redo surgery. The mean age was 7.47 ± 5.1 months with a female-to-male ratio of 2:1. The mean duct size was 4.67 ± 1.36 millimeters. The study found significant differences between the two approaches regarding the operative time (P-Value <0.001), at which group B consumed only 38.67% of total operative time. The surgical morbidities were reduced and intra-operative injuries were better avoided in group B with group A having 77.8% of total intra-operative complications (P-Value <0.001). Post-operative complications were more common in group A (P-Value 0.014). The post-operative hospital stay was markedly reduced in group B (P-Value <0.001). The study also showed significant improvement in LV systolic function, dimensions, and LA/AO ratio at 3 and 6 months post-ligation.
Conclusion: The extra-pleural approach is a safer and more effective surgical method for PDA closure due to its reduced morbidities, improved visualization, and shorter operative times.

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