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Is delayed surgery really better for congenital diaphragmatic hernia?: a prospective randomized clinical trial
M N de la Hunt1, N Madden, J E Scott
1Department of Paediatric Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, England.
Insights
Early versus delayed surgery for congenital diaphragmatic hernia showed similar survival rates in a randomized trial. Optimal timing for congenital diaphragmatic hernia repair requires further investigation.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Delayed surgery for congenital diaphragmatic hernia is common practice, often based on historical data.
- Previous comparisons relied on retrospective controls, lacking robust evidence.
Purpose of the Study:
- To compare outcomes of early versus delayed surgical repair for congenital diaphragmatic hernia in a prospective randomized trial.
- To determine the optimal timing for surgical intervention in infants with congenital diaphragmatic hernia.
Main Methods:
- Fifty-four infants with congenital diaphragmatic hernia were randomized into two groups: early repair (within 4 hours) and delayed repair (after 24 hours).
- Outcomes assessed included survival rates, hospital stay duration, ventilator dependency, and survival time.
Main Results:
- The delayed repair group had a higher survival rate (57%) compared to the early repair group (46%), but this difference was not statistically significant.
- No significant differences were observed between groups in length of hospital stay, ventilator dependency, or survival time.
- Eight infants in the delayed repair group died before surgery.
Conclusions:
- The study did not find a significant difference in survival rates between early and delayed surgical repair for congenital diaphragmatic hernia.
- The optimal timing for surgical repair of congenital diaphragmatic hernia remains unclear and warrants further research.
Abstract:
Delayed surgery has become widely accepted in the management of congenital diaphragmatic hernia after comparing outcomes only with historical retrospective controls. It was the aim of this study to compare early and delayed hernia repair in a randomized prospective clinical trial. Fifty-four infants were randomized to receive either early repair (within 4 hours of admission) or delayed repair (more than 24 hours after birth). The survival rate was higher for the delayed group (57% v 46%), but the difference was not significant (difference: -11; 95% confidence limits: -37.5, 15.5). There were no significant differences between the two groups with respect to length of hospital stay, ventilator dependency, or survival time. Recorded preoperative risk factors were similar for the two groups. Eight infants in the delayed repair group died without having undergone surgery. The optimum time for surgery still needs clarification.
