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.
Similar content being viewed by others
References
Brownlee EM, Howatson AG, Davis CF, Sabharwal AJ (2009) The hidden mortality of congenital diaphragmatic hernia: a 20-year review. J Pediatr Surg 44(2):317–320
Sluiter I, van de Ven CP, Wijnen RM, Tibboel D (2011) Congenital diaphragmatic hernia: still a moving target. Semin Fetal Neonatal Med 16(3):139–144
Vivante A, Bilik R, Schushan Eisen I, Kuint J (2008) Congenital diaphragmatic hernia: 22 years experience in a single tertiary medical center. Isr Med Assoc J 10(12):880–883
Tovar JA (2012) Congenital diaphragmatic hernia. Orphanet J Rare Dis 7:1
Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst A, Gorett Silva M, Greenough A, Tibboel D (2010) Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology 98(4):354–364
van den Hout L, Sluiter I, Gischler S, De Klein A, Rottier R, Ijsselstijn H, Reiss I, Tibboel D (2009) Can we improve outcome of congenital diaphragmatic hernia? Pediatr Surg Int 25(9):733–743
de Buys Roessingh AS, Dinh-Xuan AT (2009) Congenital diaphragmatic hernia: current status and review of the literature. Eur J Pediatr 168(4):393–406
Moyer V, Moya F, Tibboel R, Losty P, Nagaya M, Lally KP (2002) Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants. Cochrane Database Syst Rev (3):CD001695
Shah SR, Wishnew J, Barsness K, Gaines BA, Potoka DA, Gittes GK, Kane TD (2009) Minimally invasive congenital diaphragmatic hernia repair: a 7-year review of one institution’s experience. Surg Endosc 23(6):1265–1271
Cass DL (2005) Fetal surgery for congenital diaphragmatic hernia: the North American experience. Semin Perinatol 29(2):104–111
Okuyama H, Kitano Y, Saito M, Usui N, Morikawa N, Masumoto K, Takayasu H, Nakamura T, Ishikawa H, Kawataki M, Hayashi S, Inamura N, Nose K, Sago H (2011) The Japanese experience with prenatally diagnosed congenital diaphragmatic hernia based on a multi-institutional review. Pediatr Surg Int 27(4):373–378
Keijzer R, Puri P (2010) Congenital diaphragmatic hernia. Semin Pediatr Surg 19(3):180–185
Garriboli M, Duess JW, Ruttenstock E, Bishay M, Eaton S, De Coppi P, Puri P, Hollwarth ME, Pierro A (2012) Trends in the treatment and outcome of congenital diaphragmatic hernia over the last decade. Pediatr Surg Int 28(12):1177–1181
Losty PD, Vanamo K, Rintala RJ, Donahoe PK, Schnitzer JJ, Lloyd DA (1998) Congenital diaphragmatic hernia–does the side of the defect influence the incidence of associated malformations? J Pediatr Surg 33(3):507–510
Samangaya RA, Choudhri S, Murphy F, Zaidi T, Gillham JC, Morabito A (2012) Outcomes of congenital diaphragmatic hernia: a 12-year experience. Prenat Diagn 32(6):523–529
Jancelewicz T, Vu LT, Keller RL, Bratton B, Lee H, Farmer D, Harrison M, Miniati D, Mackenzie T, Hirose S, Nobuhara K (2010) Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution. J Pediatr Surg 45(1):155–160 (discussion 160)
Chiu PP, Ijsselstijn H (2012) Morbidity and long-term follow-up in CDH patients. Eur J Pediatr Surg 22(5):384–392
Hedrick HL, Crombleholme TM, Flake AW, Nance ML, von Allmen D, Howell LJ, Johnson MP, Wilson RD, Adzick NS (2004) Right congenital diaphragmatic hernia: Prenatal assessment and outcome. J Pediatr Surg 39(3):319–323 (discussion 319–323)
Bryner BS, Kim AC, Khouri JS, Drongowski RA, Bruch SW, Hirschl RB, Mychaliska GB (2009) Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival. J Pediatr Surg 44(5):883–887
Fisher JC, Jefferson RA, Arkovitz MS, Stolar CJ (2008) Redefining outcomes in right congenital diaphragmatic hernia. J Pediatr Surg 43(2):373–379
Colvin J, Bower C, Dickinson JE, Sokol J (2005) Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 116(3):e356–e363
Midrio P, Gobbi D, Baldo V, Gamba P (2007) Right congenital diaphragmatic hernia: an 18-year experience. J Pediatr Surg 42(3):517–521
van den Hout L, Reiss I, Felix JF, Hop WC, Lally PA, Lally KP, Tibboel D (2010) Risk factors for chronic lung disease and mortality in newborns with congenital diaphragmatic hernia. Neonatology 98(4):370–380
Seetharamaiah R, Younger JG, Bartlett RH, Hirschl RB (2009) Factors associated with survival in infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 44(7):1315–1321
Deprest J, Jani J, Van Schoubroeck D, Cannie M, Gallot D, Dymarkowski S, Fryns JP, Naulaers G, Gratacos E, Nicolaides K (2006) Current consequences of prenatal diagnosis of congenital diaphragmatic hernia. J Pediatr Surg 41(2):423–430
Skari H, Bjornland K, Haugen G, Egeland T, Emblem R (2000) Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pediatr Surg 35(8):1187–1197
Azarow K, Messineo A, Pearl R, Filler R, Barker G, Bohn D (1997) Congenital diaphragmatic hernia–a tale of two cities: the Toronto experience. J Pediatr Surg 32(3):395–400
Wilson JM, Lund DP, Lillehei CW, Vacanti JP (1997) Congenital diaphragmatic hernia–a tale of two cities: the Boston experience. J Pediatr Surg 32(3):401–405
Wynn J, Krishnan U, Aspelund G, Zhang Y, Duong J, Stolar CJ, Hahn E, Pietsch J, Chung D, Moore D, Austin E, Mychaliska G, Gajarski R, Foong YL, Michelfelder E, Potolka D, Bucher B, Warner B, Grady M, Azarow K, Fletcher SE, Kutty S, Delaney J, Crombleholme T, Rosenzweig E, Chung W, Arkovitz MS (2013) Outcomes of congenital diaphragmatic hernia in the modern era of management. J Pediatr 163(1):114.e111–119.e111
Jawaid WB, Qasem E, Jones MO, Shaw NJ, Losty PD (2013) Outcomes following prosthetic patch repair in newborns with congenital diaphragmatic hernia. Br J Surg 100(13):1833–1837
Kesieme EB, Kesieme CN (2011) Congenital diaphragmatic hernia: review of current concept in surgical management. ISRN Surg 2011:974041
Brindle ME, Brar M, Skarsgard ED (2011) Patch repair is an independent predictor of morbidity and mortality in congenital diaphragmatic hernia. Pediatr Surg Int 27(9):969–974
Verbelen T, Lerut T, Coosemans W, De Leyn P, Nafteux P, Van Raemdonck D, Deprest J, Decaluwe H (2013) Antireflux surgery after congenital diaphragmatic hernia repair: a plea for a tailored approach. Eur J Cardiothorac Surg 44(2):263–267 (discussion 268)
Skari H, Bjornland K, Frenckner B, Friberg LG, Heikkinen M, Hurme T, Loe B, Mollerlokken G, Nielsen OH, Qvist N, Rintala R, Sandgren K, Wester T, Emblem R (2002) Congenital diaphragmatic hernia in Scandinavia from 1995 to 1998: predictors of mortality. J Pediatr Surg 37(9):1269–1275
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Duess, J.W., Zani-Ruttenstock, E.M., Garriboli, M. et al. Outcome of right-sided diaphragmatic hernia repair: a multicentre study. Pediatr Surg Int 31, 465–471 (2015). https://doi.org/10.1007/s00383-015-3695-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-015-3695-y