J Korean Assoc Pediatr Surg.  2001 Jun;7(1):21-25.

The Result of Delayed Operation in Congenital Diaphragmatic Hernia

• Lee SK
• Kim HH
• Kim KH
• Chang YS
• Park WS

Abstract

Congenital diaphragmatic hernia (CDH) in the past was considered a surgical emergency requiring immediate operation. Several groups now advocate preoperative stabilization and delayed surgery. The treatment strategy for CDH in this institution is delayed surgery after preoperative stabilization. The aim of this study was to evaluate the results of delayed surgery. A retrospective review of 16 neonates with CDH was performed. Surfactant, conventional mechanical ventilation, high frequency oscillation, and nitric oxide were utilized for preoperative stabilization as necessary. The difference in outcome between two groups differentiated by the duration of the preoperative stabilization periods with mechanical ventilation (< or = 8 hours and >8 hours) was determined. Chi-square test was used to analyze the data. There were 7 right-sided hernias and 9 left. The average duration of stabilization was 32.4 hours. Hepatic herniation through the defect was found in 6 cases and all died. The most common postoperative complication was pneumothorax. The mortality rate of the right side hernia was higher than the left (85.7% vs. 33.3%, p=0.036). Mortality rate of the group (N=8) whose preoperative stabilization period was 8 hours or less was better than that (N=6) whose preoperative stabilization period was more than 8 hours (25.0% vs. 83.3%, p=0.031). The overall mortality rate was 56.3%. The better prognosis was noticed in left side hernia, no liver herniation, or shorter preoperative stabilization period.

Keyword

Congenital diaphragmatic hernia; Preoperative stabilization; Delayed surgery

MeSH Terms

Emergencies
Hernia
Hernia, Diaphragmatic*
Humans
Infant, Newborn
Liver
Mortality
Nitric Oxide
Pneumothorax
Postoperative Complications
Prognosis
Respiration, Artificial
Retrospective Studies
Nitric Oxide