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Recurrence in congenital diaphragmatic hernia: A multicenter, postdischarge pilot study
Vikas S Gupta1, Kylie I Holden1, Priscilla P Chiu2
1Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX.
Surgery
|February 20, 2025
Summary
Congenital diaphragmatic hernia recurrence occurred in 12% of infants, with higher rates linked to high-risk factors like extracorporeal life support and minimally invasive repair. Defect size also impacts recurrence timing and rates over five years.
Area of Science:
- Pediatric Surgery
- Neonatal Outcomes
- Hernia Research
Background:
- Limited multicenter data existed on postdischarge outcomes for congenital diaphragmatic hernia (CDH).
- Previous studies identified factors for early CDH recurrence.
- This study addresses the gap in understanding long-term recurrence rates.
Purpose of the Study:
- To assess congenital diaphragmatic hernia recurrence rates within the first five years of life.
- To analyze postdischarge outcomes in a multicenter cohort.
- To identify factors influencing CDH recurrence after initial management.
Main Methods:
- Retrospective data collection from four centers (2010-2021).
- Inclusion of infants with CDH managed in outpatient settings.
- Primary outcome: CDH recurrence requiring surgical correction, with follow-up at discharge, 2, and 5 years.
Main Results:
- Overall recurrence rate was 12% (35/297 patients) with long-term follow-up.
- Higher recurrence in high-risk (17%) vs. low-risk (8%) patients.
- Extracorporeal life support (23%) and minimally invasive surgery (35%) were associated with increased recurrence compared to open repair (7%).
Conclusions:
- Congenital diaphragmatic hernia recurrence is influenced by defect size, extracorporeal life support, and surgical approach.
- Smaller defects may recur earlier; larger defects show steady recurrence over five years.
- Findings are crucial for guiding patient counseling and follow-up strategies.
