IS DELAYED SURGERY REALLY BETTER FOR CONGENITAL DIAPHRAGMATIC-HERNIA - A PROSPECTIVE RANDOMIZED CLINICAL-TRIAL

Delayed surgery has become widely accepted in the management of congen ital diaphragmatic hernia after comparing outcomes only with historica l retrospective controls. It was the aim of this study to compare earl y and delayed hernia repair in a randomized prospective clinical trial . Fifty-four infants were randomized to receive either early repair (w ithin 4 hours of admission) or delayed repair (more than 24 hours afte r birth). The survival rate was higher for the delayed group (57% v 46 %), but the difference was not significant (difference: -11; 95% confi dence limits: -37.5, 15.5). There were no significant differences betw een the two groups with respect to length of hospital stay, ventilator dependency, or survival time. Recorded preoperative risk factors were similar for the two groups. Eight infants in the delayed repair group died without having undergone surgery. The optimum time for surgery s till needs clarification. Copyright (C) 1996 by W.B. Saunders Company