Related Experiment Video
Updated: Jul 14, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Predicting the need for fundoplication at the time of congenital diaphragmatic hernia repair
Ivan R Diamond1, Kandice Mah, Peter C W Kim
1Division of General Surgery, The Hospital for Sick Children, Toronto, Canada M5G 1X8.
Insights
Children with congenital diaphragmatic hernia (CDH) needing surgery may require later intervention for gastroesophageal reflux (GER). Liver in the chest or patch repair are key risk factors for GER intervention in CDH patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring surgical repair.
- Gastroesophageal reflux (GER) is a common complication in infants with CDH.
- Predicting the need for subsequent GER intervention is crucial for patient management.
Purpose of the Study:
- To identify preoperative factors predicting the need for intervention for GER in children with CDH.
- To inform surgical strategies and postoperative care for CDH patients.
Main Methods:
- Retrospective cohort study of 86 children undergoing CDH repair (1995-2002).
- Exclusion criteria: in-hospital mortality or fundoplication at initial CDH repair.
- Logistic regression analysis to identify predictive preoperative factors for GER intervention.
Main Results:
- 13 out of 86 children (15.1%) required subsequent intervention for GER.
- Univariate predictors: right-sided CDH, nonconventional ventilation, liver herniation, patch repair.
- Multivariate analysis identified liver herniation and patch repair as significant predictors (PPV 69.2%, NPV 87.7%).
Conclusions:
- Infants with CDH and liver herniation or requiring patch repair are at higher risk for GER intervention.
- Consideration of fundoplication during initial CDH repair may benefit this high-risk subpopulation.
Purpose:
This study was conducted to examine the preoperative factors predictive of subsequent intervention for gastroesophageal reflux (GER) in children with congenital diaphragmatic hernia (CDH).
Methods:
We conducted a retrospective cohort study on children who underwent repair of a CDH between January 1, 1995, and December 31, 2002 with follow-up continuing to September 1, 2005. Excluded in the study were children who died during their first admission, or who underwent fundoplication at the time of CDH repair. Univariate and multivariate logistic regressions were performed to examine preoperative factors predictive of subsequent intervention (fundoplication or gastrojejunal tube placement).
Results:
Of 86 children, 13 underwent intervention (fundoplication, 10; gastrojejunal tube, 3) for GER. Univariate predictors included the following: right-sided CDH, use of nonconventional ventilation, liver within the chest, and patch closure of the CDH. However, only liver within the chest and patch closure of the CDH were significant predictors in a multiple variable analysis. The positive and negative predictive values of the multivariate model were 69.2% and 87.7%, respectively.
Conclusions:
Infants with CDH who have liver within the chest or require patch closure of their hernia are at increased risk for subsequent intervention for GER. These children may represent a subpopulation that would benefit from fundoplication at the time of CDH repair.
