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.

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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 Dec. 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

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