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Optimal early surgery timing for congenital diaphragmatic hernia: A systematic review
H Poerwosusanta1, D Aditia2, Gunadi2
1Lambung Mangkurat University, Faculty of Medicine, Department of Surgery, Pediatric Surgery Division, Banjarmasin, South Kalimantan, Indonesia. herpoerwo@ulm.ac.id.
Insights
Optimal surgical timing for congenital diaphragmatic hernia (CDH) remains unclear. This systematic review found no significant difference in mortality or survival rates between early and delayed CDH repair, regardless of severity.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Developmental Biology
Background:
- Congenital diaphragmatic hernia (CDH) results from faulty embryogenesis, leading to intra-abdominal contents herniating into the chest.
- Optimal surgical timing for CDH repair requires further clarification.
Conclusions:
- Surgical timing for congenital diaphragmatic hernia (CDH) repair does not impact mortality rates, irrespective of disease severity.
- Surgery is performed once physiological indices are achieved, indicating stability.
Introduction:
Congenital diaphragmatic hernia (CDH) is a failure of closure of the pleuro-peritoneal canal due to faulty embryogenesis caused herniation of intra-abdominal contents into the chest. There needs to be more clarity about the optimal surgical timing for CDH. The aim of this study is to determine the optimal surgical timing for CDH using a systematic review analysis.
Materials And Methods:
Our study used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. The literature search approach used publications between 2013 and 2023 using Pubmed and SagePub databases. Studies were included if they contained reports of the best timing for emergency surgery for CHD repair. We did not include review articles and unpublished data.
Results:
Five articles met the criteria. The overall result, the first pre-operative 24-hour oxygenation index mean, was temporally reliable and representative (intraclass correlation coefficient = 0.70, 95% CI = 0.61-0.77). Within any severity level, there were no differences in 90-day survival or mortality rate between delayed repair and early repair (p = 0.002). As a result, there is no optimal timing for surgery in severe cases of CDH. A delay in repair did not predict an increased risk of death, nor did it suggest an increased need for post-operative extracorporeal membrane oxygen therapy.
Conclusion:
Regardless of the severity of the illness, the timing of CDH repair does not affect the mortality rate.Surgery is done after the physiology index achievement.
