Independent original articlePredicting the need for fundoplication at the time of congenital diaphragmatic hernia repair
Section snippets
Method
We performed a retrospective cohort study on all patients who underwent repair of a posterolateral (Bochdalek) CDH between January 1, 1995, and December 31, 2002 at the Hospital for Sick Children in Toronto. The observation period continued until September 31, 2005 to ensure adequate capture of patients who received intervention for symptomatic GER. Children were excluded from the cohort if they died during the same admission as their CDH repair, or if they underwent a concurrent antireflux
Results
A total of 108 children underwent CDH repair during the index time period. Nineteen of these children died during their initial hospitalization, and 3 underwent fundoplication at the time of CDH repair. These 22 children were excluded, and therefore the retrospective cohort comprised 86 children.
Thirty-eight patients (44%) received pharmacologic therapy for GER. Thirty-six (42%) children received acid suppression, whereas 33 (38%) were prescribed prokinetic medications. Of the 86 children, 13
Discussion
Gastroesophageal reflux was only identified as a significant problem in survivors of CDH in the 1990s [2], [3], [4]. Estimates of the incidence of GER within the CDH population range from 12% to 69% [6]. However, an incidence of up to 81% has been demonstrated in those who received extracorporeal membrane oxygenation (ECMO) before repair of their CDH [7]. A number of mechanisms for the development of GER in this population have been proposed. Most of these relate to developmental consequences
Acknowledgments
The authors would like to thank Robin Vaughan for her assistance with this project. Ivan Diamond was supported by the Surgeon Scientist Training Program, Department of Surgery, University of Toronto.
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Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice
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2018, Avery's Diseases of the Newborn: Tenth EditionLong-term morbidity of congenital diaphragmatic hernia: A plea for standardization
2017, Seminars in Pediatric SurgeryCitation Excerpt :The mediastinal shift and compression during fetal life, the esophageal kinking at the gastroesophageal junction, the deviation and shortening of the abdominal esophagus, the closure of the diaphragmatic defect under excessive tension, also causing an elevated pressure gradient across the hiatus, and the absence of the peri-hiatal diaphragm, are common in CDH patients. Accordingly, GER disease (GER requiring medical or surgical treatment) and the need for surgery have a higher prevalence in patients with a more severe disease and/or anatomical defect as indicated by liver or stomach in the chest,44,48–50 prenatal diagnosis of CDH,51 and need for ECMO or patch closure.28,44,45,48,49,52,53 In CDH survivors, GER may be asymptomatic.
Respiratory Disorders in the Term Infant
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2014, Seminars in Pediatric SurgeryCitation Excerpt :GER may be managed with anti-reflux medication but a significant number of CDH survivors may require fundoplication to ameliorate symptoms and minimise morbidity. Studies from Toronto and Leuven have both defined groups at greatest risk which include ECMO survivors, babies having patch repair, i.e., large defects and FETO “liver up” cases.1,33,34 In Liverpool, with aggressive multidisciplinary team (MDT) medical management of GER only 10% of our patient population have required fundoplication.18