Congenital diaphragmatic hernia repair analysis in relation to postoperative abdominal compartment syndrome and
Karina Miura da Costa1,2, Amulya Kumar Saxena3
1Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.
Insights
Congenital diaphragmatic hernia (CDH) repair in neonates may lead to abdominal compartment syndrome (ACS) and require delayed abdominal closure (DAC). Clearer criteria are needed for DAC in CDH to prevent ACS.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes
Background:
- Congenital diaphragmatic hernia (CDH) often presents with limited abdominal space.
- This can lead to abdominal compartment syndrome (ACS), necessitating delayed abdominal closure (DAC).
Purpose of the Study:
- To review outcomes of pediatric patients undergoing ACS/DAC following CDH repair.
- To identify trends and complications associated with these procedures.
Main Methods:
- A systematic review of Medline/PubMed, Scopus, Web of Science, Ovid, and Lilacs databases.
- Data collection from studies published between 1990-2020 in English, Spanish, or Portuguese.
- Descriptive statistical analysis of collected data.
Main Results:
- The review included 118 children, predominantly neonates (94.9%).
- ACS occurred in 5.1% of cases, diagnosed clinically or via Doppler/bladder pressure.
- Delayed abdominal closure (DAC) was performed in 94.9% of cases, with silo placement being the most common approach (32.1%).
- Complications after DAC were reported in 8.1% of patients, and overall mortality was 17%.
Conclusions:
- ACS and DAC are frequent in neonates post-CDH repair.
- The rationale for DAC is often unclear, and abdominal pressure measurement is not consistently reported.
- Standardized criteria for DAC in CDH are essential to prevent ACS, especially in cases with large herniated contents and small abdominal volumes.
Aim:
Limited abdominal space in congenital diaphragmatic hernia (CDH) might result in abdominal compartment syndrome (ACS) and require delayed abdominal closure (DAC). This study reviewed outcomes in pediatric ACS/DAC after CDH repair.
Methods:
Medline/PubMed, Scopus, Web of Science, Ovid and Lilacs databases were reviewed. Data from studies published in English/Spanish/Portuguese between 1990-2020 was collected. Results are presented as descriptive statistics.
Results:
Sixteen reports offered 118 children, 112 (94.9%) being neonates. There were six ACS (5.1%) and 112 DAC (94.9%). Regarding ACS, the diagnosis was made clinically (n = 4; 66.7%), using Doppler scans (n = 1; 16.7%) or bladder pressure measurement (n = 1; 16.7%). There was one (16.7%) lethal outcome. The rationale to perform DAC was not clearly stated, and measurement of abdominal pressure was not mentioned in all reports. Silo was the preferred approach in 36 children (32.1%), followed by skin closure only (n = 16; 14.3%), vacuum (n = 10; 8.9%), fascia patch and skin closure (n = 5; 4.5%), fascia patch and vacuum dressing (n = 1; 0.9%), fasciotomy (n = 1; 0.9%); with no DAC technique reported in 43 patients (38.4%). Complications after DAC were reported in nine children (8.1%). One DAC using vacuum dressing that was clinically diagnosed with ACS required silo placement. There were 19 (17%) lethal outcomes.
Conclusions:
ACS/DAC after CDH repair are reported more frequently in neonates (112/118; 94.9%). There is no clear rationale stated behind the decision to perform DAC, with the silo being the preferred approach. Criteria need to be worked for DAC in CDH with large herniated content and small volume abdomen to prevent ACS.
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