Short Term Surgical Outcomes in the Treatment of Congenital Diaphragmatic Hernia: An Overview of 15 Years Experience

Introduction: Congenital diaphragmatic hernia (CDH) is characterized by a defect of the diaphragm, pulmonary hypoplasia and pulmonary hypertension. Data on surgical outcome are scarce since pulmonary function seems to predominate the outcome. This study gives an overview of recent short term surgical outcomes of a large single center cohort. Method: All CDH patients treated in a high volume centre, from 2000-2015, were retrospectively evaluated. Surgical outcome was described. Furthermore, demographics, patient and CDH characteristics and treatments were registered. Differences in these parameters between survivors and non-survivors were analyzed. Results: In total 215 patients were included, with a 1-year mortality rate of 27%. Of the 197 repaired patients, 40% needed patch repair. In most patients the abdominal fascia could be closed after the repair (77%), however in 15% an abdominal patch was needed, because both the fascia and skin could not be closed. In total 31% of the patients had surgical complications, of which 14% hemorrhage postoperative, 17% chylothorax and recurrence occurred in 6% within one year/ recurrence showed no statistical difference between primary and patch repair (p=1.00). No patch infections were encountered. Surgical hemorrhage and chylothorax were encountered significantly more in non-survivors compared to survivors (30% versus 5%, p=< 0.001, 28% versus 14%, p=0.04, respectively). An abdominal patch was needed in 28% of non-survivors and 8% of survivors (p< 0.001). Conclusion: This overview shows the incidence of surgical short term outcome in a high volume center. Survivors had a significant lower incidence of surgical complications and had a relatively low recurrence rate within one year (6%).