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Technology assessment for management of congenital diaphragmatic hernia: immediate versus delayed surgery
1Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
Insights
Delayed surgical repair for congenital diaphragmatic hernia (CDH) in neonates may improve survival rates. However, evidence remains inconclusive, with some studies showing benefits and others no significant difference compared to immediate surgery.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes
Background:
- Congenital diaphragmatic hernia (CDH) is a critical pediatric surgical condition, particularly in neonates presenting within 6 hours of birth.
- Surgical timing for CDH has evolved from immediate repair to a strategy involving stabilization and delayed surgery, though its benefit is debated.
Purpose of the Study:
- To compare the outcomes of delayed surgical repair versus immediate surgery for neonates with symptomatic congenital diaphragmatic hernia.
- To evaluate whether delayed repair improves survival rates in this patient population.
Main Methods:
- A literature search was conducted in MEDLINE and the Cochrane Database for studies on congenital diaphragmatic hernia and surgery.
- Inclusion criteria encompassed randomized controlled trials, prospective trials, retrospective analyses, and meta-analyses.
- Data from 25 studies were analyzed using Epi Info Version 3, with statistical significance set at p < 0.05.
Main Results:
- Analysis of 25 studies (2 RCTs, 23 RAs) indicated that pre-operative stabilization and delayed surgery improved survival in 14 studies (p < 0.05).
- The remaining 11 studies found no statistically significant difference in survival between immediate and delayed surgery groups (p > 0.05).
Conclusions:
- Evidence-based analysis suggests that the optimal timing for congenital diaphragmatic hernia surgery (immediate vs. delayed) remains unclear.
- Clinical experience suggests that pre-operative stabilization followed by delayed surgery may enhance survival in neonates with CDH compared to immediate surgical intervention.
Background:
Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in pediatric surgery, especially in neonates with symptom presentation within 6 hours after birth. Opinion regarding the time of surgery has gradually shifted from immediate repair to a policy of stabilization and delayed repair. Whether delayed surgery is beneficial remains controversial.
Objective:
To evaluate the outcomes regarding whether delayed surgical repair improves survival in CDH neonates, who are symptomatic immediately after delivery, is more beneficial than immediate surgery.
Material And Method:
Data were obtained by searching MEDLINE (1966-2002) and the Cochrane Database, Issue 2, 2003 using the term "congenital diaphragmatic hernia" and "surgery". Inclusion criteria were randomized controlled trial (RCT), prospective trial (PT), retrospective analysis (RA) and meta-analysis (MA). Information from the literature was analyzed by the computer program of Epi Info Version 3. Statistical significance was reliable at the level of p < 0.05.
Results:
Twenty-five studies were obtained and RCT:RA was 2:23. Analysis of results of CDH management revealed that pre-operative stabilization and delayed surgery improved the survival rate in 14 of 25 in the literature (p < 0.05), while the remaining 11 articles showed no statistical difference of survival between immediate and delayed surgery (p > 0.05).
Conclusion:
From the evidence-based analysis, the results of CDH management between immediate versus delayed surgery were unclear. From the reviewer's experience at the Queen Sirikit National Institute of Child Health, the strategy of pre-operative stabilization and delayed surgery had better improved survival of CDH than immediate surgery.