The management of Bochdalek congenital diaphragmatic hernia: a single center experience and review of the literature

Yıl 2020, Cilt: 6 Sayı: 2, 138 - 144, 04.03.2020

Sefer Tolga Okay Serpil Sancar , Esra Özçakır , İpek Güney Varal Pelin Doğan Mete Kaya

https://doi.org/10.18621/eurj.467162

Cited By: 1

Öz

Objectives:
Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly of the
diaphragm with pulmonary hypoplasia and persistent pulmonary hypertension and
has serious consequences. Despite recent diagnosis and treatment strategies,
CDH is still a challenging condition. We aim to present our clinical
experiences of CDH, and review of the literature.

Methods: Data of
CDH patients who were operated in our clinic between January 2010 and September
2018 were obtained from the patient's chart. The clinical course and results of
the patients with Bochdalek type CDH were reviewed.

Results: We
performed diaphragmatic closure in 16 patients with Bochdalek CDH during study
period. Fourteen (82%) cases were diagnosed antenatally. In 5 (29%) patients,
preoperative pulmonary hypertension developed and nitric oxide was
administered. Twelve of the sixteen patients (75%) underwent primary repair and
4 of them underwent prosthetic patch. Three patients were repaired
thoracoscopically. Five (31%) patients died due to severe persistent pulmonary
hypertension on postoperative period. There was no recurrence in our patients
who were followed-up for a mean of 27 months.

Conclusion: In
the management of Bochdalek CDH, the clinical success has been increasing in
parallel with the important developments with the application of new treatment
modalities in the neonatal intensive care units and new surgical techniques in
recent years.

Anahtar Kelimeler

Bochdalek hernia, congenital diaphragmatic hernia, newborn, pulmonary hypertension

Kaynakça

• 1. Losty PD. Congenital diaphragmatic hernia: where and what is the evidence? Semin Pediatr Surg 2014;23:278-82.
• 2. Leeuwen L, Fitzgerald DA. Congenital diaphragmatic hernia. J Paediatr Child Health 2014;50:667-73.
• 3. Ameis D, Khoshgoo N, Keijzer R. Abnormal lung development in congenital diaphragmatic hernia. Semin Pediatr Surg 2017;26:123-8.
• 4. Puligandla PS, Grabowski J, Austin M, Hedrick H, Renaud E, Arnold M, et al. Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee. J Pediatr Surg 2015;50:1958-70.
• 5. Benachi A, Cordier AG, Cannie M, Jani J. Advances in prenatal diagnosis of congenital diaphragmatic hernia. Semin Fetal Neonatal Med 2014;19:331-7.
• 6. Daodu O, Brindle ME. Predicting outcomes in congenital diaphragmatic hernia. Semin Pediatr Surg 2017;26:136-9.
• 7. McHoney M. Congenital diaphragmatic hernia, management in the newborn. Pediatr Surg Int 2015;31:1005-13.
• 8. Harting MT. Congenital diaphragmatic hernia-associated pulmonary hypertension. Semin Pediatr Surg 2017;26:147-53.
• 9. Beurskens LW, Schrijver LH, Tibboel D, Wildhagen MF, Knapen MF, Lindemans J, et al. Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring. Birth Defects Res A Clin Mol Teratol 2013;97:60-6.
• 10. Keller RL, Tacy TA, Hendricks-Munoz K, Xu J, Moon-Grady AJ, Neuhaus J, et al. Congenital diaphragmatic hernia: endothelin-1, pulmonary hypertension, and disease severity. Am J RespirCrit Care Med 2010;182:555-61.
• 11. Sbragia L, Nassr AC, Gonçalves FL, Schmidt AF, Zuliani CC, Garcia PV, et al. VEGF receptor expression decreases during lung development in congenital diaphragmatic hernia induced by nitrofen. Braz J Med Biol Res 2014;47:171-8.
• 12. Snoek KG, Reiss IK, Greenough A, Capolupo I, Urlesberger B, Wessel L, et al. Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update. Neonatology 2016;110:66-74.
• 13. Barroso C, Correia-Pinto J. Perioperative complications of congenital diaphragmatic hernia repair. Eur J Pediatr Surg 2018;28:141-7.
• 14. Maxwell D, Baird R, Puligandla P. Abdominal wall closure in neonates after congenital diaphragmatic hernia repair. J Pediatr Surg 2013;48:930-4.
• 15. Silen ML, Canvasser DA, Kurkchubasche AG, Andrus CH, Naunheim KS. Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia. Ann Thorac Surg 1995;60:448-50.