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Right versus left congenital diaphragmatic hernia - What's the difference?
Carmen Mesas Burgos1, Björn Frenckner1, Matias Luco2
1Department of Pediatric Surgery, Karolinska Institutet, Stockholm, Sweden.
Journal of Pediatric Surgery
|November 11, 2017
Summary
Right-sided congenital diaphragmatic hernias (CDH) are not inherently worse; larger defect sizes, more common in right-sided cases, explain poorer survival. Defect size, not side, is the key factor impacting outcomes in CDH patients.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Thoracic Surgery
Background:
- Right-sided congenital diaphragmatic hernias (CDH) are often associated with worse patient outcomes.
- Defect size is a known prognostic factor in CDH.
Purpose of the Study:
- To compare outcomes between right- and left-sided CDH.
- To evaluate the impact of defect size and side on survival and morbidity in CDH patients.
Main Methods:
- Analysis of a multicenter, multinational CDH registry (2007-2015).
- Comparison of outcomes based on defect laterality (right vs. left).
- Statistical analysis correlating defect side and size with survival and associated anomalies.
Main Results:
- Overall survival for CDH was 71% (3754 cases).
- Right-sided CDH (16%) had a lower survival rate (67%) compared to left-sided (72%).
- Right-sided CDH presented with a higher proportion of large defects (C & D); survival was similar for comparable defect sizes regardless of side.
Conclusions:
- The higher incidence of large defects in right-sided CDH accounts for the observed poorer survival.
- Defect size, rather than the laterality of the defect, is the primary determinant of survival in congenital diaphragmatic hernia.
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