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Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open

Katrin B Zahn1,2, Thomas Schaible2,3, Neysan Rafat3

  • 1Department of Pediatric Surgery, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany.

Frontiers in Pediatrics
|January 3, 2022
PubMed

Insights

Congenital diaphragmatic hernia (CDH) repair complications, including recurrence, depend on surgical technique. Long-term radiologic screening is crucial for early detection and improved outcomes after neonatal CDH repair.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Neonatal Medicine

Background:

  • Recurrence is a severe complication after neonatal congenital diaphragmatic hernia (CDH) repair, with reported rates up to 50% after patch implantation.
  • Previous studies on CDH repair complications are limited by varying surgical techniques, retrospective designs, and lack of standardized follow-up or imaging.
  • Reliable detection of complication rates and identification of risk factors are needed for improved patient outcomes.

Purpose of the Study:

  • To reliably detect complication rates using radiologic screening during longitudinal follow-up after neonatal open CDH repair.
  • To identify independent risk factors associated with diaphragmatic complications and recurrence after CDH repair.
  • To propose a risk-stratified approach for managing diaphragmatic complications post-CDH repair.

Main Methods:

  • A 12-year longitudinal follow-up study of consecutive neonates undergoing open CDH repair at a referral center with a standardized treatment algorithm.
  • Radiologic screening at defined intervals was used to monitor for recurrence and diaphragmatic complications.
  • Multivariate analysis was employed to identify independent risk factors for complications.

Main Results:

  • Out of 326 neonates with a minimum 2-year follow-up, 38 (11.6%) experienced recurrence or secondary hiatal hernias.
  • Diaphragmatic complications occurred in 8.6% of patients after discharge, significantly associated with initial defect size.
  • Independent risk factors for complications included left-sided CDH (RR 8.5), abdominal wall patch (RR 3.2), and age ≤4 years (RR 6.5).

Conclusions:

  • The long-term complication rate after CDH repair is highly dependent on surgical technique, with broad cone-shaped patches potentially achieving lower recurrence rates.
  • Longitudinal follow-up with regular radiologic imaging until adolescence is essential for detecting recurrence and preventing severe complications.
  • A risk-stratified approach to diaphragmatic complications, informed by surgical technique and patient factors, is proposed.

Keywords:
CDHcone-shaped patchcongenital diaphragmatic hernialongitudinal follow-upradiologic screeningrecurrencerisk factors for recurrencesecondary hiatal hernia

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