Our Summary

This research looks into the issue of small bowel obstruction (SBO) following surgery to repair Congenital Diaphragmatic Hernia (CDH) - a birth defect that affects the diaphragm. This obstruction can cause severe health problems and can even be fatal. The researchers studied 120 cases of CDH births from January 2010 to September 2022, to understand how often SBO happens and what might increase the risk of it happening.

They found that 16 out of 120 patients (13%) developed SBO, almost all of which were due to sticky bands called adhesives. Most of these cases required further surgery. The study showed that the risk of developing SBO increases if the neonate required ECMO (a treatment that uses a pump to circulate blood through an artificial lung), had a gastrostomy tube (a tube inserted into the stomach to assist with feeding), underwent a fundoplication operation (a surgery to prevent stomach acid from backing up into the esophagus), took longer to have the initial CDH repair, or had longer initial hospital stays.

In simpler terms, newborns with more severe health conditions, who need more intensive treatments, take longer to recover, or stay in the hospital longer are more likely to develop SBO after CDH surgery. Over 90% of those who did develop SBO ended up needing surgery.

FAQs

  1. What is the incidence of small bowel obstruction following congenital diaphragmatic hernia repair?
  2. What are the risk factors for developing small bowel obstruction after congenital diaphragmatic hernia repair?
  3. Do all patients who develop small bowel obstruction after congenital diaphragmatic hernia repair require further surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to be aware of the potential risk of developing small bowel obstruction (SBO) following the repair. It is important to discuss with your healthcare provider any risk factors that may increase the likelihood of developing SBO, such as the need for extracorporeal membrane oxygenation (ECMO), prior abdominal surgeries like gastrostomy tube placement or fundoplication, and longer hospitalizations. Being proactive and discussing these risks with your healthcare team can help in early detection and management of SBO if it occurs.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who are at increased risk for small bowel obstruction (SBO) following repair include those who:

  • Required extracorporeal membrane oxygenation (ECMO)
  • Had prior gastrostomy tube placement
  • Had prior fundoplication
  • Had a longer time to initial CDH repair
  • Had a longer initial hospitalization

These factors suggest a higher acuity of illness in these patients, which may predispose them to developing adhesive SBO post-operatively. More than 90% of patients who developed SBO required surgical intervention, highlighting the importance of early recognition and management of this complication.

Timeline

Timeline of patient experiences before and after congenital diaphragmatic hernia repair:

Before CDH repair:

  1. Diagnosis of CDH during prenatal ultrasound or after birth
  2. Stabilization of the patient’s condition in the neonatal intensive care unit (NICU)
  3. Monitoring of respiratory function and possible need for mechanical ventilation
  4. Evaluation for associated anomalies and potential need for additional surgeries
  5. Preparation for CDH repair surgery, including discussion of risks and benefits

After CDH repair:

  1. Immediate post-operative recovery in the intensive care unit (ICU)
  2. Monitoring for complications such as respiratory distress, infection, and bowel obstruction
  3. Gradual weaning off of respiratory support and pain medications
  4. Transition to general pediatric care and discharge from the hospital
  5. Long-term follow-up with a pediatric surgeon and other specialists to monitor for potential complications, including small bowel obstruction
  6. Possible need for additional surgeries or interventions depending on the patient’s individual course of recovery from CDH repair.

What to Ask Your Doctor

  1. What is my risk of developing small bowel obstruction following congenital diaphragmatic hernia repair?
  2. What are the common causes of small bowel obstruction in patients who have undergone CDH repair?
  3. How soon after CDH repair might I experience symptoms of small bowel obstruction?
  4. What are the signs and symptoms of small bowel obstruction that I should watch out for?
  5. What are the treatment options for small bowel obstruction in patients who have undergone CDH repair?
  6. Are there any specific risk factors in my case that increase my likelihood of developing small bowel obstruction?
  7. How will small bowel obstruction be diagnosed and managed in my specific situation?
  8. Will I require surgical intervention if I develop small bowel obstruction?
  9. Are there any preventive measures I can take to reduce my risk of developing small bowel obstruction after CDH repair?
  10. What is the long-term outlook for patients who have experienced small bowel obstruction following CDH repair?

Reference

Authors: Schmoke N, Cali F, Wilken T, Midura D, Nemeh C, Fan W, Khlevner J, Duron V. Journal: Am Surg. 2024 Dec;90(12):3223-3228. doi: 10.1177/00031348241266633. Epub 2024 Jul 20. PMID: 39030940