Our Summary

The research looked at patients with Congenital Diaphragmatic Hernia (CDH), a birth defect where there is a hole in the diaphragm, and who needed their abdomen to be closed after it was opened for the CDH repair surgery. They looked at patients from 2004 to 2014 and found that out of 233 patients, 21 of them needed their abdomen to be closed later after the surgery.

This delay in closing the abdomen was more common in patients who were on a life support machine called Extracorporeal Membrane Oxygenation (ECMO) during the surgery. Different methods, such as using the skin only, using a special mesh, or using a vacuum assisted device, were used to temporarily cover the abdomen until it could be closed. The time it took to actually close the abdomen varied, but was on average about 14.5 days for patients on ECMO and about 6 days for those not on ECMO.

Interestingly, the researchers found that patients who needed their abdomen to be closed later didn’t necessarily fare worse. They didn’t have different prenatal predictors, didn’t spend more time on ECMO, and their survival rates were not different. However, they did need more blood transfusions.

In conclusion, while delayed closing of the abdomen was more common in patients who were on ECMO during CDH repair, it didn’t necessarily lead to worse outcomes, but did require more blood transfusions.

FAQs

  1. What is Congenital Diaphragmatic Hernia (CDH) and what does the repair surgery involve?
  2. What factors were found to influence the delay in closing the abdomen after CDH repair surgery?
  3. Did delayed closing of the abdomen after CDH repair surgery affect the patient’s survival rates or other outcomes?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to be prepared for the possibility of a delayed closure of the abdomen after surgery, especially if the patient is on ECMO during the procedure. It is important to discuss this possibility with the medical team and understand the potential need for additional blood transfusions. Trust in the expertise of the healthcare providers and follow their guidance for the best outcome.

Suitable For

Therefore, patients who are typically recommended for congenital diaphragmatic hernia repair are those with a confirmed diagnosis of CDH, especially those who may require ECMO support during surgery. These patients may need to have their abdomen temporarily closed after surgery, but this does not necessarily impact their overall outcome. Close monitoring and potentially additional interventions, such as blood transfusions, may be necessary in these cases.

Timeline

Overall timeline of a patient’s experience before and after congenital diaphragmatic hernia repair:

  • Pre-surgery: Patient is diagnosed with congenital diaphragmatic hernia during prenatal ultrasound or shortly after birth. They may undergo prenatal interventions to improve lung growth and development.

  • Surgery: Patient undergoes CDH repair surgery, during which the abdominal cavity is opened to repair the hole in the diaphragm. Some patients may require ECMO support during the surgery.

  • Post-surgery: Patients who need their abdomen to be closed later after the surgery undergo temporary closure methods, such as using the skin only, special mesh, or a vacuum-assisted device. The time it takes to close the abdomen varies, with an average of about 14.5 days for patients on ECMO and about 6 days for those not on ECMO.

  • Follow-up: Patients who undergo delayed closure of the abdomen may require more blood transfusions but do not necessarily have worse outcomes in terms of survival rates. Long-term follow-up may be needed to monitor for any potential complications or issues related to the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about congenital diaphragmatic hernia repair may include:

  1. What is the best method for closing the abdomen after CDH repair surgery?
  2. How long will it typically take for the abdomen to be closed after surgery?
  3. Are there any potential complications or risks associated with delayed closure of the abdomen?
  4. Will being on ECMO during surgery increase the likelihood of needing delayed closure of the abdomen?
  5. How will delayed closure of the abdomen affect my recovery and long-term outcomes?
  6. Will I require additional interventions or treatments if my abdomen needs to be closed later?
  7. What measures will be taken to ensure the safety and success of the delayed closure procedure?
  8. How will delayed closure of the abdomen impact my need for blood transfusions and other medical interventions?
  9. Are there any specific factors or conditions that may increase the likelihood of needing delayed closure of the abdomen after CDH repair surgery?
  10. What can I expect in terms of follow-up care and monitoring after the delayed closure procedure?

Reference

Authors: Laje P, Hedrick HL, Flake AW, Adzick NS, Peranteau WH. Journal: J Pediatr Surg. 2016 Feb;51(2):240-3. doi: 10.1016/j.jpedsurg.2015.10.069. Epub 2015 Nov 11. PMID: 26653950