The Result of Delayed Operation in Congenital Diaphragmatic Hernia

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The Result of Delayed Operation in Congenital Diaphragmatic Hernia

21 Vol. 7. No. 1. June 2001

Suk-Koo Lee, M.D., Hyun-Hahk Kim, M.D., Kyung-Hun Kim, M.D., Yun-Sil Chang, M.D.*, and Won-Soon Park, M.D.*

Division of Pediatric Surgery, Department of Pediatrics*, Samsung Medical Center, Sungkyunkwan University School of Medicine

Seoul, Korea

Congenital diaphragmatic hernia (CDR) in the past was considered a surgical emergency requiring immediate operation. Several groups now advocate preoperative stabilization and delayed surgery. The treatment strategy for CDH in this institution is delayed surgery after preoperative stabilization. The aim of this study was to evaluate the results of delayed surgery. A retrospective review of 16 neonates with CDH was performed. Surfactant.

conventional mechanical ventilation. high frequency oscillation. and nitric oxide were utilized for preoperative stabilization as necessary. The difference in outcome between two groups differentiated by the duration of the preoperative stabilization periods with mechanical ventilation (s:; 8 hours and > 8 hours) was determined. Chi-square test was used to analyze the data. There were 7 right-sided hernias and 9 left. The average duration of stabilization was 32.4 hours. Hepatic herniation through the defect was found in 6 cases and all died. The most common postoperative complication was pneumothorax. The mortality rate of the right side hernia was higher than the left (85.7% vs. 33.3%. p=0.036). Mortality rate of the group (N=8) whose preoperative stabilization period was 8 hours or less was better than that (N=6) whose preoperative stabilization period was more than 8 hours (25.0% vs. 83.3%.

p=0.030. The overall mortality rate was 56.3%. The better prognosis was noticed in left side hernia. no liver herniation. or shorter preoperative stabilization period. (J Kor Assoc Pediatr Surg 7(1):21-25, 2001)

Index Words: Con.f!enital diaphraJWlQtic hernia. Preoperative stabilization. Delaved sur.f!ery

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Table 1. Liver Herniation and Outcome

Liver herniation Death Survival Total

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Table 2. Postoperative Pneumothorax and Outcome Pneumothorax Death Survival Total

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25

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