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Congenital Diaphragmatic Eventration: Should we Maintain Surgical Treatment? A Retrospective Multicentric Cohort
Lymeymey Heng1, Khalid Alzahrani1, Louise Montalva2
1Pediatric Surgery Unit, Federation of Pediatrics, University Hospital Centre, Angers, France.
Insights
Surgical diaphragmatic plication effectively treats pediatric congenital diaphragmatic eventration (CDE) in symptomatic children. However, this intervention carries a 29% complication rate and a 7% recurrence risk.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Abnormalities
Background:
- Congenital diaphragmatic eventration (CDE) is a rare condition affecting children.
- Understanding CDE characteristics and treatment outcomes is crucial for pediatric care.
Purpose of the Study:
- To describe the characteristics of pediatric patients with CDE.
- To compare surgical versus conservative treatment outcomes for CDE in France.
Main Methods:
- Retrospective cohort study including 139 children (<16 years) diagnosed with CDE (2010-2021).
- Compared outcomes between surgical (diaphragmatic plication) and conservative management.
- Level III treatment study.
Main Results:
- 68.3% of CDE cases occurred in boys; 66.7% were right-sided.
- 87 patients (62%) underwent initial surgery, while 52 (38%) received conservative treatment (25 later operated).
- Post-treatment, respiratory symptoms decreased from 64% to 14%, and diaphragmatic dome level improved.
Conclusions:
- Diaphragmatic plication is effective for symptomatic CDE with diaphragmatic dome above the 6th posterior rib.
- The procedure is associated with a 29% complication rate and 7% recurrence.
- Treatment decisions should weigh efficacy against potential complications.
Background:
The aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France.
Methods:
Retrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared.
Results:
139 patients were included, with a median age of 8 [1-16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients.
Conclusions:
Diaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence.
Clinicaltrials:
NCT04862494, April 28, 2021.
Level Of Evidence:
level III treatment study.
