Outcome of right-sided diaphragmatic hernia repair: a multicentre study
- 457 Downloads
Right-sided congenital diaphragmatic hernia (R-CDH) occurs in 14 to 25 % of all CDH cases. The current literature comparing the outcome of R-CDH vs left CDH (L-CDH) is inconsistent, with some studies reporting higher and others lower mortality in R-CDH compared to L-CDH. The aim of our multicentre study was to analyse characteristics and outcome of R-CDH.
We retrospectively reviewed the medical records of 178 consecutive infants with CDH who underwent surgical repair of CDH at three European tertiary pediatric surgical centres from three different countries between 2000 and 2009. The analysis focused on demographic data, morbidity and mortality in R-CDH compared with L-CDH.
Out of a total of 178 children, 32 (18.0 %) right-sided and 146 (82.0 %) left-sided cases of CDH were identified. Prenatal diagnosis was made in 8 R-CDH vs 67 L-CDH (25.0 vs 45.9 %, p = 0.030). Median gestational age in R-CDH was 39 weeks (range 29–42 weeks) and 39 weeks in L-CDH (range 28–43 weeks, p = 0.943). Median birth weight in R-CDH was 3233 g (range 905–4480 g) and in L-CDH was 3060 g (range 1065–5240 g, p = 0.184). Major associated anomalies were present in 19 R-CDH vs 46 L-CDH (59.4 vs 31.5 %, p = 0.003). Extracorporeal membrane oxygenation (ECMO) was required in 3 R-CDH vs 19 L-CDH (9.4 vs 13.0 %, p = 0.571). A diaphragmatic patch was used in 13 R-CDH and 59 L-CDH (40.6 vs 40.4 %, p = 0.982). Fundoplication for GERD was required in 1 R-CDH and 19 L-CDH (3.1 vs 13.0 %, p = 0.109). No significant differences were observed in recurrence rate (9.4 vs 8.9 %, p = 0.933). Postoperative mortality rate was significantly higher in R-CDH compared to L-CDH (21.9 vs 8.2 %, p = 0.023). In R-CDH, prenatal diagnosis and patch repair correlated with mortality by univariate regression (p = 0.005 and p = 0.019).
This multicentre study shows that prenatal diagnosis and patch repair were associated with an increased mortality rate in R-CDH. However, the morbidity following repair of R-CDH was not significantly different from that in L-CDH in survivors.
KeywordsCongenital diaphragmatic hernia Right-sided congenital diaphragmatic hernia Left-sided congenital diaphragmatic hernia Extracorporeal membrane oxygenation Surgical repair Outcome Survival
- 5.Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst A, Gorett Silva M, Greenough A, Tibboel D (2010) Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology 98(4):354–364CrossRefPubMedGoogle Scholar
- 8.Moyer V, Moya F, Tibboel R, Losty P, Nagaya M, Lally KP (2002) Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants. Cochrane Database Syst Rev (3):CD001695Google Scholar
- 11.Okuyama H, Kitano Y, Saito M, Usui N, Morikawa N, Masumoto K, Takayasu H, Nakamura T, Ishikawa H, Kawataki M, Hayashi S, Inamura N, Nose K, Sago H (2011) The Japanese experience with prenatally diagnosed congenital diaphragmatic hernia based on a multi-institutional review. Pediatr Surg Int 27(4):373–378CrossRefPubMedGoogle Scholar
- 16.Jancelewicz T, Vu LT, Keller RL, Bratton B, Lee H, Farmer D, Harrison M, Miniati D, Mackenzie T, Hirose S, Nobuhara K (2010) Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution. J Pediatr Surg 45(1):155–160 (discussion 160)CrossRefPubMedGoogle Scholar
- 24.Seetharamaiah R, Younger JG, Bartlett RH, Hirschl RB (2009) Factors associated with survival in infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 44(7):1315–1321CrossRefPubMedGoogle Scholar
- 29.Wynn J, Krishnan U, Aspelund G, Zhang Y, Duong J, Stolar CJ, Hahn E, Pietsch J, Chung D, Moore D, Austin E, Mychaliska G, Gajarski R, Foong YL, Michelfelder E, Potolka D, Bucher B, Warner B, Grady M, Azarow K, Fletcher SE, Kutty S, Delaney J, Crombleholme T, Rosenzweig E, Chung W, Arkovitz MS (2013) Outcomes of congenital diaphragmatic hernia in the modern era of management. J Pediatr 163(1):114.e111–119.e111CrossRefGoogle Scholar
- 34.Skari H, Bjornland K, Frenckner B, Friberg LG, Heikkinen M, Hurme T, Loe B, Mollerlokken G, Nielsen OH, Qvist N, Rintala R, Sandgren K, Wester T, Emblem R (2002) Congenital diaphragmatic hernia in Scandinavia from 1995 to 1998: predictors of mortality. J Pediatr Surg 37(9):1269–1275CrossRefPubMedGoogle Scholar