BACKGROUND/ PURPOSE: Surgical complications are common in survivors of congenital diaphragmatic hernia (CDH), but little is known about long-term incidence patterns and associated predictors. METHODS: A cohort of 99 CDH survivors was prospectively followed at a single-institution multidisciplinary clinic. Data were gathered regarding the adverse surgical outcomes of hernia recurrence, chest and spinal deformity, and operative small bowel obstruction (SBO), and then were retrospectively analyzed in relation to perinatal and perioperative markers of disease severity to determine significant predictors. Statistical methods used included univariate and multivariate regression analysis, hazard modeling, and Kaplan-Meier analysis. RESULTS: At a median cohort age of 4.7 (range, 0.2-10.6) years, 46% of patients with patch repairs and 10% of those with primary repairs had a hernia recurrence at a median time of 0.9 (range, 0.1-7.3) years after repair. Chest deformity was detected in 47%. Small bowel obstruction and scoliosis occurred in 13%. Recurrence and chest deformity were significantly more common with patch repair, liver herniation, age at neonatal extubation greater than 16 days, oxygen requirement at discharge, and prematurity. The strongest predictor of SBO was patch repair. Multivariate analysis showed that patch repair was independently predictive of recurrence and early chest deformity (odds ratios of 5.0 and 4.8, confidence intervals of 1-24 and 1-21, P < .05). Use of an absorbable patch was associated with the highest risk of surgical complications. CONCLUSIONS: For long-term survivors of CDH, specific perinatal and operative variables, particularly patch repair, are associated with subsequent adverse surgical outcomes. Copyright 2010. Published by Elsevier Inc.
BACKGROUND/ PURPOSE: Surgical complications are common in survivors of congenital diaphragmatic hernia (CDH), but little is known about long-term incidence patterns and associated predictors. METHODS: A cohort of 99 CDH survivors was prospectively followed at a single-institution multidisciplinary clinic. Data were gathered regarding the adverse surgical outcomes of hernia recurrence, chest and spinal deformity, and operative small bowel obstruction (SBO), and then were retrospectively analyzed in relation to perinatal and perioperative markers of disease severity to determine significant predictors. Statistical methods used included univariate and multivariate regression analysis, hazard modeling, and Kaplan-Meier analysis. RESULTS: At a median cohort age of 4.7 (range, 0.2-10.6) years, 46% of patients with patch repairs and 10% of those with primary repairs had a hernia recurrence at a median time of 0.9 (range, 0.1-7.3) years after repair. Chest deformity was detected in 47%. Small bowel obstruction and scoliosis occurred in 13%. Recurrence and chest deformity were significantly more common with patch repair, liver herniation, age at neonatal extubation greater than 16 days, oxygen requirement at discharge, and prematurity. The strongest predictor of SBO was patch repair. Multivariate analysis showed that patch repair was independently predictive of recurrence and early chest deformity (odds ratios of 5.0 and 4.8, confidence intervals of 1-24 and 1-21, P < .05). Use of an absorbable patch was associated with the highest risk of surgical complications. CONCLUSIONS: For long-term survivors of CDH, specific perinatal and operative variables, particularly patch repair, are associated with subsequent adverse surgical outcomes. Copyright 2010. Published by Elsevier Inc.
Authors: P Kuklová; D Zemková; M Kyncl; K Pycha; Z Straňák; J Melichar; J Snajdauf; M Rygl Journal: Pediatr Surg Int Date: 2011-09-20 Impact factor: 1.827
Authors: Pramod Puligandla; Erik Skarsgard; Martin Offringa; Ian Adatia; Robert Baird; Michelle Bailey; Mary Brindle; Priscilla Chiu; Arthur Cogswell; Shyamala Dakshinamurti; Hélène Flageole; Richard Keijzer; Douglas McMillan; Titilayo Oluyomi-Obi; Thomas Pennaforte; Thérèse Perreault; Bruno Piedboeuf; S. Patricia Riley; Greg Ryan; Anne Synnes; Michael Traynor Journal: CMAJ Date: 2018-01-29 Impact factor: 8.262
Authors: Johannes W Duess; Elke M Zani-Ruttenstock; Massimo Garriboli; Prem Puri; Agostino Pierro; Michael E Hoellwarth Journal: Pediatr Surg Int Date: 2015-03-24 Impact factor: 1.827