Our Summary

The researchers aimed to develop a way to identify a “dome shape” in the diaphragm after it has been surgically repaired, using chest x-rays. They wanted to see if this dome-shaped repair, using a special patch, was associated with a lower rate of recurrence of a condition called congenital diaphragmatic hernia (CDH). To do this, they looked back over the medical records of all newborns who were treated for CDH at their institution between January 2004 and August 2017, and had at least six months of follow-up after their surgery.

They found that out of 192 newborns who fit their criteria, 96% survived, and the CDH recurrence rate was 15%. They found that of the babies who received a patch repair, those with a dome repair had a higher use of a life support treatment (ECMO) and longer hospital stays. However, their CDH recurrence rate was about half of those with a non-dome repair.

In layman’s terms, the study suggests that repairing the diaphragm in a certain “dome” shape after CDH might lead to a lower chance of the condition coming back, even though it might mean a longer hospital stay and more intensive treatment. The researchers note that larger studies across multiple institutions are needed to confirm these findings.

FAQs

  1. What was the aim of the researchers in this study about congenital diaphragmatic hernia repair?
  2. What is the difference in the recurrence rate of CDH between babies who had a dome-shaped repair and those who had a non-dome repair?
  3. Does a dome-shaped repair of the diaphragm result in longer hospital stays and more intensive treatment for babies with CDH?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to discuss the possibility of a dome-shaped repair with their surgeon. While this type of repair may require more intensive treatment and a longer hospital stay, it could potentially lower the risk of the condition recurring in the future. It is important to have a thorough discussion with your healthcare provider about the benefits and risks of different repair options to make an informed decision about the best course of treatment for your specific situation.

Suitable For

Patients who are typically recommended for congenital diaphragmatic hernia repair are newborns or infants who have been diagnosed with CDH. This condition occurs when there is a hole in the diaphragm, allowing abdominal organs to move into the chest cavity and potentially compress the lungs and heart. Surgery is usually required to repair the hole and move the organs back into their correct position.

In this study, the researchers specifically looked at newborns who underwent surgery for CDH and had at least six months of follow-up. They found that those who received a dome-shaped repair using a special patch had a lower rate of CDH recurrence compared to those who had a non-dome repair. However, the dome repair group had a higher use of ECMO (life support treatment) and longer hospital stays.

Overall, patients with CDH who are recommended for surgery are those who are at risk of complications due to the hernia, such as respiratory distress or cardiovascular issues. The decision to undergo surgery and the specific type of repair recommended will depend on the individual patient’s condition and the recommendations of their medical team.

Timeline

Before CDH repair:

  • A baby is diagnosed with congenital diaphragmatic hernia (CDH) either prenatally or shortly after birth through imaging tests.
  • The baby may experience difficulty breathing, feeding issues, and other symptoms due to the hernia.
  • The baby undergoes surgery to repair the hole in the diaphragm, typically within the first few days or weeks of life.

After CDH repair:

  • The baby is monitored closely in the hospital for complications and recovery from surgery.
  • The baby may require respiratory support, such as a ventilator or ECMO (extracorporeal membrane oxygenation), to help with breathing.
  • The baby undergoes follow-up appointments and tests to monitor for any signs of CDH recurrence.
  • The baby may require ongoing medical care and support to manage any long-term effects of CDH and the surgical repair.

What to Ask Your Doctor

Patient questions for their doctor about congenital diaphragmatic hernia repair:

  1. What type of surgical repair will be performed for my child’s congenital diaphragmatic hernia?
  2. Will a dome-shaped repair be considered for my child? What are the potential benefits and risks associated with this type of repair?
  3. How will the decision be made regarding the type of repair to be performed?
  4. What are the expected outcomes and recovery time for each type of repair?
  5. What is the likelihood of CDH recurrence with the chosen repair method?
  6. Will additional treatment, such as ECMO, be needed if a dome-shaped repair is performed?
  7. Are there any long-term implications or considerations to take into account with the chosen repair method?
  8. Are there any alternative treatment options or considerations to discuss?
  9. Will my child require ongoing monitoring or follow-up care after the surgery?
  10. Are there any specific questions or concerns I should keep in mind as we move forward with the treatment plan?

Reference

Authors: Verla MA, Style CC, Lee TC, Menchaca AD, Lau PE, Mehollin-Ray AR, Fernandes CJ, Keswani SG, Olutoye OO. Journal: J Pediatr Surg. 2022 Apr;57(4):637-642. doi: 10.1016/j.jpedsurg.2021.10.014. Epub 2021 Oct 22. PMID: 34836640