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Gastroesophageal reflux after repair of congenital diaphragmatic hernia
1Department of Pediatric Surgery, Hospital Saint Vincent de Paul, Paris, France.
Insights
Gastroesophageal reflux (GER) affects 62% of congenital diaphragmatic hernia (CDH) survivors, particularly those with prenatal diagnosis. Surgical techniques may reduce GER-related complications in CDH patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring surgical repair.
- Gastroesophageal reflux (GER) is a common complication following CDH repair, impacting patient outcomes.
- Understanding the incidence and risk factors for GER is crucial for improving management strategies.
Purpose of the Study:
- To determine the incidence of gastroesophageal reflux (GER) in survivors of congenital diaphragmatic hernia (CDH) repair.
- To identify factors associated with GER in this patient population.
- To propose potential surgical modifications to mitigate GER-related morbidity.
Main Methods:
- Retrospective review of 74 congenital diaphragmatic hernia (CDH) survivors.
- Assessment for gastroesophageal reflux (GER) through clinical signs and documentation.
- Correlation analysis of GER with diagnostic timing, preoperative stomach position, and surgical interventions.
Main Results:
- The overall incidence of GER was 62% (46 of 74 patients).
- GER was significantly more common in patients with prenatal CDH diagnosis (75.8%) and preoperative thoracic stomach position.
- Patients with GER experienced significantly longer durations of artificial ventilation and hospitalization.
Conclusions:
- Gastroesophageal reflux (GER) is highly prevalent in congenital diaphragmatic hernia (CDH) survivors, especially with prenatal diagnosis.
- Preoperative thoracic stomach position is a significant risk factor for GER.
- Surgical strategies involving diaphragmatic and parietal patches may help reduce GER morbidity.
Abstract:
Seventy-four survivors of congenital diaphragmatic hernia (CDH) repair were reviewed for gastroesophageal reflux (GER). Twenty-nine patients had a prenatal diagnosis of CDH, 31 had the diagnosis established during the first 60 minutes of life, and 14 had a late diagnosis. Fifty-seven of the 60 patients with a prenatal diagnosis or diagnosis at birth had their CDH repaired during the first 24 hours of life. Thirty-six of the 37 patients with clinical signs of GER and 10 patients without typical clinical signs had documented GER. The overall incidence of GER was 62% (46 of 74). The 46 comprised 22 of the 29 patients (75.8%) with a prenatal diagnosis of CDH, 21 of the 31 (67.7%) with a diagnosis at birth, and 3 of the 14 with a late diagnosis. Eleven patients had surgical treatment of GER. A significant correlation was found between GER and the preoperative thoracic position of the stomach (32 v 8, GER+ v GER-; P < .01) and GER and the prenatal diagnosis of CDH (22 v 7, GER+ v GER-; P < .01). Duration of artificial ventilation (68.97 +/- 15.33 days v 14.14 +/- 3.89 days, GER+ v GER-; P < .005) and duration of hospitalization (22.04 +/- 3.59 weeks v 3.9 +/- 0.88 weeks, GER+ v GER-; P < .0003) were significantly longer for the patients with pathological GER. To decrease the morbidity related to GER, we propose using diaphragmatic patches during hernia repair to lower the strain on the crus, and using parietal patches to lower intraabdominal pressure after reintroduction of the herniated viscera.