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Small Bowel Obstruction Following Congenital Diaphragmatic Hernia Repair-Incidence and Risk Factors
Nicholas Schmoke1, Francesca Cali1, Terri Wilken1
1Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
The American Surgeon
|July 20, 2024
Summary
Small bowel obstruction (SBO) after congenital diaphragmatic hernia (CDH) repair is common, often requiring surgery. Higher illness acuity, including ECMO and additional abdominal surgeries, increases SBO risk.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Small bowel obstruction (SBO) is a significant complication post-congenital diaphragmatic hernia (CDH) repair.
- SBO can lead to increased morbidity and mortality in affected neonates.
Purpose of the Study:
- To determine the incidence of SBO following CDH repair.
- To identify risk factors associated with SBO development after CDH repair.
Main Methods:
- Retrospective review of 120 CDH patients from January 2010 to September 2022.
- Analysis of risk factors including operative approach, repair type, ECMO, and additional abdominal surgeries (gastrostomy tube, fundoplication).
Main Results:
- 16% of patients developed SBO, primarily due to adhesive bands (94%).
- Need for ECMO, prior gastrostomy tube, prior fundoplication, longer time to CDH repair, and longer initial hospitalization were significant risk factors.
- 94% of SBO cases required surgical intervention.
Conclusions:
- Neonates with higher illness acuity (ECMO, additional surgeries, prolonged hospitalization/repair time) face increased risk of adhesive SBO post-CDH repair.
- SBO following CDH repair frequently necessitates surgical management.
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