Revisiting outcomes of right congenital diaphragmatic hernia

Adesola C. Akinkuotu, Stephanie M. Cruz, Darrell L. Cass, Christopher I. Cassady, Amy R. Mehollin-Ray, Jennifer L. Williams, Timothy C. Lee, Rodrigo Ruano, Stephen E. Welty, Oluyinka O. Olutoye

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10 Scopus citations

Abstract

Background Studies comparing outcomes of right- and left-sided congenital diaphragmatic hernia (R-CDH and L-CDH) have yielded conflicting results. We hypothesized that R-CDH is associated with higher short-term pulmonary morbidity than L-CDH. Methods We reviewed all CDH patients at a tertiary children's hospital over 10 y. In prenatally diagnosed CDH, the observed-to-expected total fetal lung volume and percentage liver herniation (%LH) were calculated using fetal magnetic resonance imaging-based measurements. Outcomes were compared in patients with isolated CDH. Patients were subsequently matched by %LH to compare outcomes. Results Of 189 CDH patients, 37 (20.1 %) were R-CDH and 147 (79.9%) were L-CDH. Those with R-CDH were prenatally diagnosed at a significantly lower rate (40.5% versus 73.5%; P < 0.001) and later gestational age (26.5 ± 7.7 versus 22.6 ± 5.65 wk; P = 0.062). There was no difference in observed-to-expected total fetal lung volume between those with R-CDH and L-CDH (30.2 ± 11.1% versus 33.1 ± 14.2%; P = 0.471). Fetuses with R-CDH had a higher %LH than those with L-CDH (37.5 ± 14.1% versus 18.6 ± 12.2%; P < 0.001). Patients with isolated R-CDH had a higher need for extracorporeal membrane oxygenation than L-CDH (48% versus 27%; P = 0.055). There was no difference in duration of tracheal intubation, hospital stay, need for supplemental oxygen at 30-d of life or 6-mo mortality between groups. There was no difference in mortality and pulmonary morbidity when patients were matched by %LH. Conclusions Compared to those with L-CDH, fetuses with R-CDH are less likely to be diagnosed prenatally and have a higher need for extracorporeal membrane oxygenation. The sidedness of the hernia defect was not associated with differences in short-term pulmonary morbidity in this large, contemporary single-institution experience of neonates with CDH.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalJournal of Surgical Research
Volume198
Issue number2
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

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Keywords

  • Liver herniation
  • Right congenital diaphragmatic hernia

ASJC Scopus subject areas

  • Surgery

Cite this

Akinkuotu, A. C., Cruz, S. M., Cass, D. L., Cassady, C. I., Mehollin-Ray, A. R., Williams, J. L., Lee, T. C., Ruano, R., Welty, S. E., & Olutoye, O. O. (2015). Revisiting outcomes of right congenital diaphragmatic hernia. Journal of Surgical Research, 198(2), 413-417. https://doi.org/10.1016/j.jss.2015.03.090