GASTROESOPHAGEAL REFLUX AFTER REPAIR OF CONGENITAL DIAPHRAGMATIC-HERNIA

Seventy-four survivors of congenital diaphragmatic hernia (CDH) repair were reviewed for gastroesophageal reflux (GER). Twenty-nine patients had a prenatal diagnosis of CDH, 31 had the diagnosis established dur ing the first 60 minutes of life, and 14 had a late diagnosis. Fifty-s even of the 60 patients with a prenatal diagnosis or diagnosis at birt h had their CDH repaired during the first 24 hours of life. Thirty-six of the 37 patients with clinical signs of GER and 10 patients without typical clinical signs had documented GER. The overall incidence of G ER was 62% (46 of 74). The 46 comprised 22 of the 29 patients (75.8%) with a prenatal diagnosis of CDH, 21 of the 31 (67.7%) with a diagnosi s at birth, and 3 of the 14 with a late diagnosis. Eleven patients had surgical treatment of GER. A significant correlation was found betwee n GER and the preoperative thoracic position of the stomach (32 v 8, G ER+ v GER-; P <.01) and GER and the prenatal diagnosis of CDH (22 v 7, GER+ v GER-; P < .01). Duration of artificial ventilation (68.97 +/- 15.33 days v 14.14 +/- 3.89 days, GER+ v GER-; P < .005) and duration of hospitalization (22.04 +/- 3.59 weeks v 3.9 +/- 0.88 weeks, GER+ v GER-; P < .0003) were significantly longer for the patients with patho logical GER. To decrease the morbidity related to GER, we propose usin g diaphragmatic patches during hernia repair to lower the strain on th e crus, and using parietal patches to lower intraabdominal pressure af ter reintroduction of the herniated viscera. Copyright (C) 1995 by W.B . Saunders Company.