Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis

Abstract

Although the evidence was insufficient, ES was clearly associated with more recurrence than was OS. Therefore, ES should not be the routine treatment for every neonate. It is crucially important to select suitable cases for ES.

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

“…[52][53][54] In addition, no studies have shown explicit "readiness for surgery" criteria that optimize outcome. [55][56][57][58][59] Although we recommend that certain physiologic criteria (including infrasystemic pulmonary artery pressures) be met before surgery, we have cautioned that failure to meet these criteria should not prevent surgery, which offers the only hope for survival. We specifically suggest that failure to meet physiologic stabilization criteria within two weeks (estimated to correspond with the time required to achieve optimal improvement in pulmonary hypertension) should prompt consideration of either attempted repair or the adoption of a palliative (nonoperative) approach, in accordance with the family's wishes.…”

“…57 However, despite technical feasibility, studies comparing minimally invasive surgery with open repair have identified a relative risk of recurrence that is three-to four-fold higher with the minimally invasive surgery approach. 58,59,63 Although the clinical implications of intraoperative hypercarbia 64 and acidosis 64,65 during minimally invasive surgical repair are unclear, the potential adverse outcomes attributable to these physiologic derangements in the context of labile pulmonary vascular resistance cannot be ignored. As such, the repair of neonatal CDH using minimally invasive surgical techniques should be performed only within the context of a trial and only after full disclosure of the known increased risk of recurrence and the potential risks associated with hypercarbia and acidosis.…”

Mortality factors in infants with congenital diaphragmatic hernia: A systematic review

“…Advancements in management of CDH (Doyle & Lally, ), extracorporeal membrane oxygenation (ECMO) and having the defect surgically repaired are among the clinical factors known to improve survival (Davis et al, ). There is further evidence that antenatal parameters such as observed‐to‐expected (O/E) lung‐to‐head ratio (LHR), the position of the liver and stomach and the O/E total fetal lung volume are also useful indicators of survival (Mayer et al, ; Morini, Goldman, & Pierro, ; Oluyomi‐Obi et al, ; Terui et al, ). However, these advances have only led to modest improvements in survival with survival rates remaining around 70% for the past two decades (Mah et al, ; McGivern et al, ).…”

“…However, these advances have only led to modest improvements in survival with survival rates remaining around 70% for the past two decades (Mah et al, ; McGivern et al, ). These clinical factors have been extensively researched and have been the focus of a number of systematic reviews and meta‐analyses (Mayer et al, ; Morini et al, ; Oluyomi‐Obi et al, ; Terui et al, ), with sociodemographic factors (e.g., infant sex and SES) only occasionally forming an additional component of the study.…”

Postnatal Ultrasound to Determine the Surgical Strategy for Congenital Diaphragmatic Hernia

“…The surgical technique for CDH has advanced, and a thoracoscopic approach has recently been introduced . The size of the diaphragm defect is an important factor for technical difficulty; a surgeon may need to convert a thoracoscopic operation to an open abdominal operation if the diaphragm defect is too large . In addition, the location of the diaphragmatic hernia may determine whether to perform primary or patch repair.…”