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Congenital Diaphragmatic Hernia: Considerations for the Adult General Surgeon
Xiao-Yue Han1, Leigh Taryn Selesner1, Marilyn W Butler2
1Department of Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L223, Portland, OR 97239, USA.
Insights
Congenital diaphragmatic hernia (CDH) management involves prenatal diagnosis, stabilization, and elective surgery. While critical, immediate surgery isn't always needed, and long-term morbidities can persist.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Medical Genetics
Background:
- Congenital diaphragmatic hernia (CDH) is a complex birth defect.
- Current management strategies are evolving.
- Prenatal diagnosis is crucial for coordinated care.
Purpose of the Study:
- To outline the current standards of care for congenital diaphragmatic hernia.
- To emphasize the importance of stabilization before surgical repair.
- To discuss the long-term implications and rare presentations of CDH.
Main Methods:
- Review of contemporary management pillars for CDH.
- Emphasis on prenatal diagnosis and multidisciplinary care.
- Discussion of medical optimization and elective surgical repair.
Main Results:
- Prenatal diagnosis facilitates coordinated care and counseling.
- Medical optimization and stabilization are key before elective surgery.
- Infants with CDH often experience persistent morbidities into adulthood.
Conclusions:
- Current CDH management prioritizes prenatal diagnosis, stabilization, and elective repair.
- Pulmonary hypertension and lung hypoplasia require medical management, not emergent surgery.
- Long-term follow-up is essential for managing persistent morbidities in CDH survivors.
Abstract:
The contemporary pillars of congenital diaphragmatic hernia (CDH) management include prenatal diagnosis for multidisciplinary care coordination and counseling, medical optimization after birth, and elective (not emergent) operative repair after stabilization, allowing for improvement in pulmonary hypertension and maturation of lungs. Lung hypoplasia and pulmonary hypertension in infants with CDH represent a medical emergency, not one that necessitates immediate surgery. Many infants surviving CDH repair have significant morbidities that may persist into adulthood. Rare cases of previously occult CDH may present acutely in the older child or adult with nonspecific gastrointestinal or pulmonary symptoms.
