[Congenital diaphragmatic hernia: have the results truly changed?]

Between 1971 and 1985, 97 patients born with posterolateral diaphragmatic hernia (CDH) were treated in three different centers in Quebec and Montreal (Canada). A retrospective study of these cases shows that with appropriate measures the results can be much less gloomy than they used to be. The series is analysed in order to determine the effect of post-operative thoracic drainage, the effect of the high frequency low volume mechanical ventilation as well as the effect of the serious associated conditions present in a significant number of these patients. Our results indicate that the ipsilateral thoracic drainage has a clear deleterious effect when used systematically++. Out of 52 such patients, 17 survived (32.7%) and 35 died (67.3%); while out of 43 patients who received no thoracic drainage, 25 survived (58.1%) and 18 died (42.8%). This is statistically significant CHI2: (p less than 0.005). If the series is analysed after elimination of the cases with severe associated conditions and taking into account the advent of the high frequency low pressure mechanical ventilation, the figures are even more significant. Fifty-seven patients (57) fall in this category; 28 patients received an ipsilateral thoracic drainage and 29 did not. In the first group 11 survived (39.2%) and 17 died (60.7%) while in the no drainage group 22 survived (75.8%) and 7 died (24.1%). This is statistically significant (p less than 0.005). We believe that with simple measures, it is possible to prevent the return to fetal circulation in a significant number of patients born with CDH and to clearly increase to overall survival rate.