Congenital diaphragmatic hernia and eventration

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Congenital Abnormalities

Background:

• Congenital diaphragmatic hernia (CDH) encompasses several conditions, including Bochdalek hernia (BH), diaphragmatic eventration (DE), and diaphragmatic agenesis (DA).
• BH is the most common type, often presenting with significant respiratory distress and associated anomalies.

Purpose of the Study:

• To critically review outcomes and mortality rates for different types of congenital diaphragmatic hernias.
• To identify factors influencing operative mortality and long-term complications in CDH patients.

Main Methods:

• Retrospective review of 52 consecutive cases of congenital diaphragmatic hernia.
• Analysis of operative mortality, associated anomalies, and postoperative complications.

Main Results:

• Operative mortality for Bochdalek hernia was 8.3%, increasing to 31.5% for infants operated within the first 24 hours.
• Diaphragmatic agenesis had a 100% mortality rate, while diaphragmatic eventration had no operative mortality.
• Factors influencing mortality included prematurity, early operation, hypoxemia, hypercarbia, acidosis, severe anomalies, and defect size.
• 24% of BH survivors developed intestinal obstruction due to adhesions, requiring surgical intervention in most cases.

Conclusions:

• Congenital diaphragmatic hernia management requires careful consideration of defect type, timing of surgery, and management of critical comorbidities.
• Long-term surveillance for complications like intestinal obstruction is essential for survivors of Bochdalek hernia.