The effect of diaphragmatic defect diameter and the presence of hernia sac in prognosis of congenital diaphragmatic hernia surgery

Abstract

Congenital diaphragmatic hernia (CDH) is a congenital malformation with challenging management. There are many prognostic factors for infants with CDH. These factors included the diameter and size of the diaphragmatic hernia defect. It seems that the larger size of diaphragmatic hernia defect causes the less prognostic for CDH and also the presence of hernia sac can effect on improvement of prognosis of patients. So, the aim of this study was assessment of the effect of size and diameter of diaphragmatic hernia defect and the presence of hernia sac on postoperative prognosis of infants with CDH. Material and methods: In this analytical descriptive study 30 infants with the diagnosis of CDH that were admitted in the Tabriz pediatric hospital since 2016- 2019 were enrolled. Primary data was obtained including patient's characteristics and clinical findings. Preoperative cares were done on the patients. Laparotomy was performed when the patients were stabilized. Presence or absence of hernia sac was evaluated and the largest diameter on diaphragmatic defect was measured before the repair. Postoperative outcome including instability, duration of mechanical ventilation, mortality rate or hospital discharge were obtained and analyzed. Results: Over the study period 30 patients with CDH met the inclusion criteria, 15 male (50%) and 15 females (50%). The mean prognostic age of patients were 8.73 days, from 3h to 30 days. Fifteen cases (50%) were diagnosed during the first 24 hours of life and Sixteen cases (53.33%) experienced hypoxia in the first hour after birth. Left sided CDH was detected in 26 patients (86.66%), 3 patients (10%) had right sided CDH and in one case (3.33%) diaphragmatic defect was bilateral. Hernia sac was present in the 9 cases (26.7%). Mean diameter of defect size in survived group was lower than nonsurvived group (4.12±0.61 cm vs. 4.61±0.48; P=0.041). Postoperative death, occurred in 9 (40.90%) of patients without hernia sac but none of cases with hernia sac expired (P = 0.035). Mean gestational age was 37.12±4.73 weeks in presence of hernia sac and 38.15±1.27 in the absence of hernia sac (P=0.336).