Outcome of Right-sided Diaphragmatic Hernia Repair: a Multicentre Study

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2015 Mar 25

PMID 25801417

Citations 12

Authors

Johannes W Duess

Elke M Zani-Ruttenstock

Massimo Garriboli

Prem Puri

Agostino Pierro

Michael E Hoellwarth

Affiliations

Soon will be listed here.

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.

Citing Articles

Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia.

Ding W, Gu Y, Wang H, Wu H, Zhang X, Zhang R Eur Radiol. 2023; 34(3):1524-1533.

PMID: 37644150 DOI: 10.1007/s00330-023-10178-1.

Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis.

Masahata K, Yamoto M, Umeda S, Nagata K, Terui K, Fujii M Pediatr Surg Int. 2022; 38(12):1745-1757.

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Neonatal intensive care unit on-site surgery for congenital diaphragmatic hernia.

Gaiduchevici A, Cirstoveanu C, Socea B, Bizubac A, Heriseanu C, Filip C Exp Ther Med. 2022; 23(6):436.

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Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open Repair of Congenital Diaphragmatic Hernia-A Large Prospective, Observational Cohort Study at One Referral Center.

Zahn K, Schaible T, Rafat N, Weis M, Weiss C, Wessel L Front Pediatr. 2022; 9:796478.

PMID: 34976900 PMC: 8719630. DOI: 10.3389/fped.2021.796478.

Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center's experience.

Jeong J, Lee B, Cha T, Jung E, Kim E, Kim K BMC Pediatr. 2021; 21(1):460.

PMID: 34666738 PMC: 8526355. DOI: 10.1186/s12887-021-02931-6.

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