Abstract
Background
Gastroesophageal reflux (GER) is common in children with congenital diaphragmatic hernia (CDH), and the optimal management in these patients is not well established. The aim of this study was to assess whether a preventive fundoplication performed during the first surgery will improve GER and nutritional morbidity in patients with a left CDH.
Methods
Thus we studied one group of 17 patients treated with a one-step antireflux procedure (group A) and a group of 19 patients with only initial diaphragmatic repair (group B) between January 1994 and December 2004. The patients were classified in three stages, mild intermediate and severe form, based on anatomic criteria (liver position and patch requirement). Most of the patients with the severe form of disease were in group A. Clinical charts were compared between the two groups with a mean follow-up of 3 years.
Results
For patients with intra-abdominal liver and direct diaphragmatic closure, the duration of hospitalization was significantly longer in group A than in group B (p = 0.08). The incidence of GER was significantly lower in group A (17.6%) than in group B (52.6%) at 1-year follow-up (p < 0.5). In the last group, 30% required a fundoplication before 6 months. Seven patients (19%) required intermittent nutritional supplementation via nasogastric tube feeding; for these patients there was no difference between the two groups. A gastrostomy was performed in only one patient. Twelve percent of patients had growth retardation during most of their first year, again with no difference between the two groups.
Conclusions
Based on the published data, recommendations can be made regarding the efficacy of adding an antireflux surgery procedure to left CDH repair in only patients with intrathoracic liver and/or patch requirement.
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References
Fasching G, Huber A, Uray E et al (2000) Gastroesophageal reflux and diaphragmatic motility after repair of congenital diaphragmatic hernia. Eur J Pediatr Surg 10:360–364
Jaillard SM, Pierrat V, Dubois A et al (2003) Outcome at 2 years of infants with congenital diaphragmatic hernia: a population-based study. Ann Thorac Surg 75:250–256
Kieffer J, Sapin E, Berg A et al (1995) Gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg 30:1330–1333
Koot VC, Bergmeijer JH, Bos AP et al (1993) Incidence and management of gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg 28:48–52
Muratore CS, Utter S, Jaksic T et al (2001) Nutritional morbidity in survivors of congenital diaphragmatic hernia. J Pediatr Surg 36:1171–1176
Stolar CJ, Levy JP, Dillon PW et al (1990) Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia. Am J Surg 159:204–207
Nagaya M, Akatsuka H, J Kato (1994) Gastroesophageal reflux occurring after repair of congenital diaphragmatic hernia. J Pediatr Surg 29:1447–1451
Sigalet DL, Nguyen LT, Adolph V et al (1994) Gastroesophageal reflux associated with large diaphragmatic hernias. J Pediatr Surg 29:1262–1265
Khalaf MN, Porat R, Brodsky NL et al (2001) Clinical correlations in infants in the neonatal intensive care unit with varying severity of gastroesophageal reflux. J Pediatr Gastroenterol Nutr 32:45–49
Beaudoin S, Kieffer G, Sapin E et al (1995) Gastroesophageal reflux in neonates with congenital abdominal wall defect. Eur J Pediatr Surg 5:323–326
Cohen MD, Beck JM (1980) Hiatus hernia: a complication of postero-lateral diaphragmatic herniation (Bochdalek hernia) in infants. Clin Radiol 31:215–219
Koivusalo A, Rintala R, Lindahl H (1999) Gastroesophageal redux in children with a congenital abdominal wall defect. J Pediatr Surg 34:1127–1129
Naik S, Greenough A, Zhang Y et al (1996) Prediction of morbidity during infancy after repair of congenital diaphragmatic hernia. J Pediatr Surg 31:1651–1654
Qi B, Soto C, Diez-Pardo JA et al (1997) An experimental study on the pathogenesis of gastroesophageal reflux after repair of diaphragmatic hernia. J Pediatr Surg 32:1310–1313
Takamatsu H, Akiyama H, Noguchi H et al (1991) Association of hiatus hernia with postero-lateral diaphragmatic hernia (Bochdalek’s hernia). Eur J Pediatr Surg 1:244–246
Kamiyama M, Kawahara H, Okuyama H et al (2002) Gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg 37:1681–1684
Chiu PP, Sauer C, Mihailovic A et al (2006) The price of success in the management of congenital diaphragmatic hernia: is improved survival accompanied by an increase in long-term morbidity? J Pediatr Surg 41:888–892
Crankson SJ, Al Jadaan SA, Namshan MA et al (2006) The immediate and long-term outcomes of newborns with congenital diaphragmatic hernia. Pediatr Surg Int 22:335–340
Lund DP, Mitchell J, Karasch V et al (1994) Congenital diaphragmatic hernia: the hidden morbidity. J Pediatr Surg 29:258–262 discussion 262–264
Vanamo K, Rintala R, Sovijärvi A et al (1996) Long-term pulmonary sequelae in survivors of congenital diaphragmatic defects. J Pediatr Surg 31:1096–1099
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Chamond, C., Morineau, M., Gouizi, G. et al. Preventive Antireflux Surgery in Patients with Congenital Diaphragmatic Hernia. World J Surg 32, 2454–2458 (2008). https://doi.org/10.1007/s00268-008-9738-y
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DOI: https://doi.org/10.1007/s00268-008-9738-y