Congenital Diaphragmatic Hernia: Is Preoperative Stabilization Beneficial?

Authors

  • Rangsan Niramis Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand
  • Sukawat Watanatittan Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand
  • Maitree Anuntkosol Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand
  • Porntep Seetalakarn Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand

Abstract

Background/Propose: Congenital diaphragmatic hernia (CDH) is one of the very high risk conditions in pediatric surgery. It has a high mortality rate in neonates with presenting symptoms shortly after birth. Results of treatment are not yet satisfactory. The purposes of this study are to review our experience with CDH and to evaluate whether preoperative stabilization with delayed surgical repair would be more beneficial than the immediate operation.

Materials and Methods: Medical records of infants with CDH admitted to the Queen Sirikit National Institute of Child Health during the period of 1992-2001 were reviewed. The study emplasized the outcomes of treatment, especially in neonates with presenting symptoms shortly after birth.

Results: There were 165 patients, male to female ratio was 1.4:1. Twenty-nine patients developed respiratory distress later than 24 hours after birth and 28 of them (96.6%) survived. The remaining 136 infants had respiratory distress within 24 hours after birth were managed in various approaches. From 1992-1994, 44 of the 136 patients underwent immediate surgical correction and 12 of 44 patients (27.7%) survived. From 1995-1997, 48 patients were treated by either immediate or partially delayed operation. Only 12 of the 48 patients (25%) survived. From 1998-2001, 44 patients were managed under the concept of preoperative stabilization with delayed operative correction. Twenty-six of the 44 patients (59.1%) survived.

Conclusion: Preoperative stabilization with delayed operative correction yielded improved survival for the treatment of CDH at our institute. Permissive hypercapnia is one of the most technique for achieving preoperative stabilization with high frequency oscillatory ventilation for stand-by use if permissive hypercarbia is ineffictive.

References

1. Vacanti JP, Crone RK, Murphy JD, Smith SD, Black PR, Reid L, et al. The pulmonary hemodynamic response to perioperative anesthesia in the treatment of high-risk infants with congenital diaphragmatic hernia. J Pediatr Surg 1984;19:672-9.

2. Cartlidge PHT, Mann NP, Kapila L. Preoperative stabilisation in congenital diaphragmatic hernia. Arch Dis Child 1986;60: 1226-8.

3. Hazebroek FWJ, Tibboel D, Bos AP, Pattenier AW, Madern GC, Bergmeijer JH, et al. Congenital diaphragmatic hernia: impact of preoperative stabilization. A perspective pilot study in 13 patients. J Pediatr Surg 1988; 23: 1139-46.

4. Langer JC, Filler RM, Bohn DJ, Shanding B, Ein SH, Wesson DE, et al. Timing of surgery for congenital diaphragmatic hernia: is emergency operation necessary? J Pediatr Surg 1988;23:731-4.

5. Shanbhogue LKR, Tan PKH, Ninan G, Lloyd DA. Pre-operative stabilisation in congenital diaphragmatic hernia. Arch Dis Child 1990; 65: 1043-4.

6. Sakai H, Tamura M, Hosokowa Y, et al. Effect of surgical repair on respiratory mechanics in congenital diaphragmatic hernia. J Pediatr 1987; 111: 432-8.

7. Nakayama DK, Motoyama EK, Tagge EM. Effect of preoperative stabilization of respiratory system compliance and outcome in newborn infants with congenital diaphragmatic hernia. J Pediatr 1991; 118: 793-9.

8. Wung JT, James LS, Kilcherdy E, James E. Management of infants with severe respiratory failure and persistence of the fetal circulation, without hyperventilation. Pediatrics 1985;76:488-94.

9. Niramis R, Watanatittan S, Suwatanaviroj A. Congenital diaphragmatic hernia: a 12-year experience in diagnosis and management. Bull Dept Med Serv 1993; 18: 317-28.

10. Wilson JM, Lund DP, Lillehei CW, Vacanti JP. Congenital diaphragmatic hernia-a tale of two cities: the Boston experience. J Pediatr Surg 1997; 32: 401-5.

11. Azarow K, Messineo A, Pearl R, Barker G, Bohn D. Congenital diaphragmatic hernia-a tale of two cities: the Toronto experience. J Pediatr Surg 1997; 32: 395-400.

12. Ladd WE, Gross RE. Congenital diaphragmatic hernia. N Engl j Med 1940; 223: 917-25.

13. Gross RE. Congenital diaphragmatic hernia. Am J Dis Child 1946;71:579-92.

14. Gross RE. The surgery of infancy and childhood. Philadelphia: WB Saunders; 1953. p. 428-44.

15. Hickling K. Low volume ventilation with permissive hypercapnia in the adult respiratory distress syndrome. Clin Intensive Care 1992; 3: 67-78.

16. Kays DW, Langham MR, Ledbetter DJ, Talbert JL. Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Ann Surg 1999; 230: 340-51.

17. Wung JT, Sahni R, Moffitt ST, Lipsitz E, Stolar CJH. Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg 1995: 30: 406-9.

18. Wiener ES. Congenital posterolateral diaphragmatic hernia: new dimensions in management. Surgery 1982; 92: 670-81.

19. Weber TR, Connors RH, Pennington G, et al. Neonatal diaphragmatic hernia and improving outlook with extra-corporeal membrane oxygenation. Arch Surg 1987; 122:615-7.

20. Stolar C, Dillon P, Reyes C, et al. Selective use of extra-corporeal membrane oxygenation in the management of congenital diaphragmatic hernia. J Pediatr Surg 1988; 23:207-11.

21. Bartlett RH, Toomasian J, Roloff D, et al. Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure 100 cases. Ann Surg 1986; 204: 236-45.

22. West KW, Bengston K, Rescola FJ, et al. Delayed surgical repair and ECMO improval in congenital diaphragmatic hernia. Ann Surg 1992; 216: 454-62.

23. Stolar CJH, Snedecor SM, Hartlett RH. Extracorporeal membrane oxygenation and neonatal respiratory failure: experience from the extracorporeal life support organization. J Pediatr Surg 1991; 26: 563-71.

24. Schumacher ER, Bards JDE, Johnson MV. Right-sided brain lesions in infants following extracorporeal membrane oxygenation. Pediatrics 1988; 82:155-61.

25. Schumacher RE, Palmer TW, Roloff DW, et al. Follow-up of infants treated with extracorporeal membrane oxygenation for newborn respiratory failure. Pediatrics 1991; 87: 451-7.

26. Hofkosh D, Thrompson AE, Nozza RJ. Ten years of extracorporeal membrane oxygenation. Neurodevelopment outcome. Pediatrics 1991; 87:549-55.

27. Lazar EL, Abramson SJ. Weingstein S, et al. Neuroimaging of brain injury in neonates treated with extracorporeal membrane oxygenation: lessons learned from serial examinations. J Pediatr Surg 1994; 29: 186-91.

28. Stolar CJH, Crisafi MA, Driscoll YT. Neurocognitive outcome for neonates treated with extracorporeal membrane oxygenation: are infants with congenital diaphragmatic hernia different? J Pediatr Surg 1995; 30: 366-72.

29. Finer NN, Barrington KJ. Nitric oxide therapy for the newborn infant. Semin Perinatol 2000;24: 59-65.

30. Finer NN, Tierney A, Etches PC, et al. Congenital diaphragmatic hernia: developing a protocolized approach. J Pediatr Surg 1998;33: 1331-7.

31. Wilson JM, Thrompson JR, Schnitzer JJ, et al. Intratracheal pulmonary. ventilation and congenital diaphragmatic hernia: a report of two cases. J Pediatr Surg 1993;28: 484-7.

32. Pranikoff T, Gauger PG, HirschI RB. Partial liquid ventilation in newborn patients with congenital diaphragmatic hernia. J Pediatr Surg 1996; 31: 613-8.

33. Wilcox DT, Glick PL, Karamanoukian HL, et al. Partial liquid ventilation and nitric oxide in congenital diaphragmatic hernia. J Pediatr Surg 1997; 32: 1211-5.

34. Greenspan JS, 'Fox WW, Rubinstein SD, et al. Partial liguid ventilation in critically ill infants receiving extracorporeal life support. Philadelphia liguid consortium. Pediatrics 1997;99:e2.

35. Harrison MR, Adzick NS, Nullard KM, et al. Correction of congenital diaphragmatic hernia VIl: a prospective trial. J Pediatr Surg 1997; 32: 1637-42.

36. Harrison MR, Adzick NS, Flake AW, et al. Correction of congenital diaphragmatic hernia in utero VIII: response of the hypoplastic lung to tracheal occlusion. J Pediatr Surg 1996;31:1339-48.

37. Harrison MR, Mychaliska GB, Albenese CT, et al. Correction of congenital diaphragmatic hernia IX: fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg 1998; 33: 1017-23.

38. Gibbs DL, Piecuch RE, Graf JL, et al. Neurodevelopmental outcome after open fetal surgery. J Pediatr Surg 1998; 33:1254-6.

Downloads

Published

2003-06-30

How to Cite

1.
Niramis R, Watanatittan S, Anuntkosol M, Seetalakarn P. Congenital Diaphragmatic Hernia: Is Preoperative Stabilization Beneficial?. Thai J Surg [Internet]. 2003 Jun. 30 [cited 2024 Nov. 23];24(2):63-8. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/242964

Issue

Vol. 24 No. 2 (2003): April - June

Section

Original Articles

License

Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.