Repair of Congenital Diaphragmatic Hernia and Eventration Of Diaphragm Without Ventilatory Support

Abstract

Background: Congenital Diaphragmatic Hernia (CDH) and eventration of Diaphragm(ED) are important causes of respiratory distress in children. CDH and ED are more a medical emergency than a surgical one and after birth, confirmation of the diagnosis should be followed by treatment in a Neonatal Intensive Care Unit (NICU) or Special Care Neonatal Unit (SCANU), Paediatric Intensive Care Unit (PICU) to stabilize the cardiovascular system. Preoperative resuscitation and delayed surgical repair with or without the use of ExtraCorporeal Membrane Oxygenation (ECMO) improves the survivality.

Methods: The medical records of all patients with CDH and ED between January 2010 and December 2015 were retrospectively reviewed. Patients’ presentation, management, operative findings and complications were evaluated.

Results: 22 patients were diagnosed as CDH or ED. Male to female ratio was 4.5:1. Age range was 2 days to 7 years, median 82.5 days. Eighteen patients were CDH and 4 patients were ED. Six patients had associated malrotation of the gut. 3 patients had Congenital Heart Disease, 1 patient had Gastroschisis and another had Hiatus hernia. Four patients expired.

Conclusion: Surgery preceded by a preoperative respiratory resuscitation and stabilization reduces postoperative mortality and increases the survival rate. Outcome was not very unsatisfactory without adequate ventilatory support.

Journal of Paediatric Surgeons of Bangladesh (2016) Vol. 7 (1): 3-10