Advertisement

Pediatric Surgery International

, Volume 31, Issue 5, pp 465–471 | Cite as

Outcome of right-sided diaphragmatic hernia repair: a multicentre study

  • Johannes W. Duess
  • Elke M. Zani-Ruttenstock
  • Massimo Garriboli
  • Prem Puri
  • Agostino Pierro
  • Michael E. Hoellwarth
Original Article

Abstract

Aim

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Congenital diaphragmatic hernia Right-sided congenital diaphragmatic hernia Left-sided congenital diaphragmatic hernia Extracorporeal membrane oxygenation Surgical repair Outcome Survival 

References

  1. 1.
    Brownlee EM, Howatson AG, Davis CF, Sabharwal AJ (2009) The hidden mortality of congenital diaphragmatic hernia: a 20-year review. J Pediatr Surg 44(2):317–320CrossRefPubMedGoogle Scholar
  2. 2.
    Sluiter I, van de Ven CP, Wijnen RM, Tibboel D (2011) Congenital diaphragmatic hernia: still a moving target. Semin Fetal Neonatal Med 16(3):139–144CrossRefPubMedGoogle Scholar
  3. 3.
    Vivante A, Bilik R, Schushan Eisen I, Kuint J (2008) Congenital diaphragmatic hernia: 22 years experience in a single tertiary medical center. Isr Med Assoc J 10(12):880–883PubMedGoogle Scholar
  4. 4.
    Tovar JA (2012) Congenital diaphragmatic hernia. Orphanet J Rare Dis 7:1CrossRefPubMedCentralPubMedGoogle Scholar
  5. 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
  6. 6.
    van den Hout L, Sluiter I, Gischler S, De Klein A, Rottier R, Ijsselstijn H, Reiss I, Tibboel D (2009) Can we improve outcome of congenital diaphragmatic hernia? Pediatr Surg Int 25(9):733–743CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    de Buys Roessingh AS, Dinh-Xuan AT (2009) Congenital diaphragmatic hernia: current status and review of the literature. Eur J Pediatr 168(4):393–406CrossRefPubMedGoogle Scholar
  8. 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
  9. 9.
    Shah SR, Wishnew J, Barsness K, Gaines BA, Potoka DA, Gittes GK, Kane TD (2009) Minimally invasive congenital diaphragmatic hernia repair: a 7-year review of one institution’s experience. Surg Endosc 23(6):1265–1271CrossRefPubMedGoogle Scholar
  10. 10.
    Cass DL (2005) Fetal surgery for congenital diaphragmatic hernia: the North American experience. Semin Perinatol 29(2):104–111CrossRefPubMedGoogle Scholar
  11. 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
  12. 12.
    Keijzer R, Puri P (2010) Congenital diaphragmatic hernia. Semin Pediatr Surg 19(3):180–185CrossRefPubMedGoogle Scholar
  13. 13.
    Garriboli M, Duess JW, Ruttenstock E, Bishay M, Eaton S, De Coppi P, Puri P, Hollwarth ME, Pierro A (2012) Trends in the treatment and outcome of congenital diaphragmatic hernia over the last decade. Pediatr Surg Int 28(12):1177–1181CrossRefPubMedGoogle Scholar
  14. 14.
    Losty PD, Vanamo K, Rintala RJ, Donahoe PK, Schnitzer JJ, Lloyd DA (1998) Congenital diaphragmatic hernia–does the side of the defect influence the incidence of associated malformations? J Pediatr Surg 33(3):507–510CrossRefPubMedGoogle Scholar
  15. 15.
    Samangaya RA, Choudhri S, Murphy F, Zaidi T, Gillham JC, Morabito A (2012) Outcomes of congenital diaphragmatic hernia: a 12-year experience. Prenat Diagn 32(6):523–529CrossRefPubMedGoogle Scholar
  16. 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
  17. 17.
    Chiu PP, Ijsselstijn H (2012) Morbidity and long-term follow-up in CDH patients. Eur J Pediatr Surg 22(5):384–392CrossRefPubMedGoogle Scholar
  18. 18.
    Hedrick HL, Crombleholme TM, Flake AW, Nance ML, von Allmen D, Howell LJ, Johnson MP, Wilson RD, Adzick NS (2004) Right congenital diaphragmatic hernia: Prenatal assessment and outcome. J Pediatr Surg 39(3):319–323 (discussion 319–323)CrossRefPubMedGoogle Scholar
  19. 19.
    Bryner BS, Kim AC, Khouri JS, Drongowski RA, Bruch SW, Hirschl RB, Mychaliska GB (2009) Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival. J Pediatr Surg 44(5):883–887CrossRefPubMedGoogle Scholar
  20. 20.
    Fisher JC, Jefferson RA, Arkovitz MS, Stolar CJ (2008) Redefining outcomes in right congenital diaphragmatic hernia. J Pediatr Surg 43(2):373–379CrossRefPubMedGoogle Scholar
  21. 21.
    Colvin J, Bower C, Dickinson JE, Sokol J (2005) Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 116(3):e356–e363CrossRefPubMedGoogle Scholar
  22. 22.
    Midrio P, Gobbi D, Baldo V, Gamba P (2007) Right congenital diaphragmatic hernia: an 18-year experience. J Pediatr Surg 42(3):517–521CrossRefPubMedGoogle Scholar
  23. 23.
    van den Hout L, Reiss I, Felix JF, Hop WC, Lally PA, Lally KP, Tibboel D (2010) Risk factors for chronic lung disease and mortality in newborns with congenital diaphragmatic hernia. Neonatology 98(4):370–380CrossRefPubMedGoogle Scholar
  24. 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
  25. 25.
    Deprest J, Jani J, Van Schoubroeck D, Cannie M, Gallot D, Dymarkowski S, Fryns JP, Naulaers G, Gratacos E, Nicolaides K (2006) Current consequences of prenatal diagnosis of congenital diaphragmatic hernia. J Pediatr Surg 41(2):423–430CrossRefPubMedGoogle Scholar
  26. 26.
    Skari H, Bjornland K, Haugen G, Egeland T, Emblem R (2000) Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pediatr Surg 35(8):1187–1197CrossRefPubMedGoogle Scholar
  27. 27.
    Azarow K, Messineo A, Pearl R, Filler R, Barker G, Bohn D (1997) Congenital diaphragmatic hernia–a tale of two cities: the Toronto experience. J Pediatr Surg 32(3):395–400CrossRefPubMedGoogle Scholar
  28. 28.
    Wilson JM, Lund DP, Lillehei CW, Vacanti JP (1997) Congenital diaphragmatic hernia–a tale of two cities: the Boston experience. J Pediatr Surg 32(3):401–405CrossRefPubMedGoogle Scholar
  29. 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
  30. 30.
    Jawaid WB, Qasem E, Jones MO, Shaw NJ, Losty PD (2013) Outcomes following prosthetic patch repair in newborns with congenital diaphragmatic hernia. Br J Surg 100(13):1833–1837CrossRefPubMedGoogle Scholar
  31. 31.
    Kesieme EB, Kesieme CN (2011) Congenital diaphragmatic hernia: review of current concept in surgical management. ISRN Surg 2011:974041CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Brindle ME, Brar M, Skarsgard ED (2011) Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia. Pediatr Surg Int 27(9):969–974CrossRefPubMedGoogle Scholar
  33. 33.
    Verbelen T, Lerut T, Coosemans W, De Leyn P, Nafteux P, Van Raemdonck D, Deprest J, Decaluwe H (2013) Antireflux surgery after congenital diaphragmatic hernia repair: a plea for a tailored approach. Eur J Cardiothorac Surg 44(2):263–267 (discussion 268)CrossRefPubMedGoogle Scholar
  34. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Johannes W. Duess
    • 1
    • 2
  • Elke M. Zani-Ruttenstock
    • 1
    • 2
  • Massimo Garriboli
    • 3
  • Prem Puri
    • 2
  • Agostino Pierro
    • 3
  • Michael E. Hoellwarth
    • 1
  1. 1.Department of Pediatric and Adolescent SurgeryMedical University of GrazGrazAustria
  2. 2.National Children’s Research CentreOur Lady’s Children’s HospitalDublin 12Ireland
  3. 3.UCL Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK

Personalised recommendations