Abdominal wall closure in neonates after congenital diaphragmatic hernia repair
Damian Maxwell1, Robert Baird, Pramod Puligandla
1West Virginia University Charleston Area Medical Center, WV, USA.
Insights
Abdominal compartment syndrome (ACS) is rare after congenital diaphragmatic hernia (CDH) repair, but delayed fascial closure (DFC) is common. DFC is linked to poorer outcomes in CDH patients.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes
Background:
- Congenital diaphragmatic hernia (CDH) repair significantly elevates intra-abdominal pressure.
- Managing intra-abdominal pressure is critical post-CDH repair.
Purpose of the Study:
- To determine the incidence and clinical significance of abdominal compartment syndrome (ACS) and delayed fascial closure (DFC) following CDH repair.
- To identify factors associated with ACS and DFC in CDH patients.
Main Methods:
- Retrospective review of the CAPSNet database (2006-2011) for CDH patients.
- Identification of patients who developed ACS or required DFC.
- Analysis of prenatal, demographic, operative, and physiological data, along with outcomes.
Main Results:
- 0.8% of CDH patients developed ACS; 12% required DFC.
- DFC was more common in right-sided CDH and associated with liver herniation.
- ACS or DFC correlated with longer hospital stays, fasting, parenteral nutrition, and mechanical ventilation.
Conclusions:
- ACS is rare (<1%) post-CDH repair, but DFC is common (>10%) and linked to right-sided defects.
- Inability to achieve primary fascial closure increases patient morbidity.
- Healthcare providers must be prepared to manage delayed fascial closure in neonates undergoing CDH repair.
Purpose:
Repair of Congenital Diaphragmatic Hernia (CDH) abruptly increases intra-abdominal pressure. This study sought to characterize the incidence and significance of ACS and delayed fascial closure (DFC) after CDH repair.
Methods:
We reviewed the CAPSNet database from 2006 to 2011, identifying the subset of patients that developed ACS or required DFC. Prenatal and demographic information, operative and physiologic details, and outcomes were investigated.
Results:
Of 349 patients with CDH, 3 (0.8%) were diagnosed with ACS, while 43 patients (12%) had DFC at the time of CDH repair. Patients more often had right-sided defects (26% vs 13%, p=0.04) and trended toward requiring a patch repair (41% vs 31.2%, p=0.23) and having a liver lobe above the diaphragmatic rim (47% vs 32.7, p=0.09). Patients with ACS or DFC had increased length of stay (47.5 vs 33.9, p=0.01), days fasting (8.2 vs 5.8, p=0.01), days on parenteral nutrition (23.6 vs 15.5, p=0.003), and days on mechanical ventilation (16.3 vs 9.0, p=0.001).
Conclusions:
While ACS in neonates after CDH repair is rare (<1%), DFC is required relatively commonly (>10%) and is associated with right-sided diaphragmatic hernias. Inability to close abdominal fascia is associated with increased morbidity. Clinicians caring for neonates with CDH should be facile with strategies to manage delayed abdominal fascia closure.
