CURRENT SURGICAL-MANAGEMENT OF CONGENITAL DIAPHRAGMATIC-HERNIA - A REPORT FROM THE CONGENITAL DIAPHRAGMATIC-HERNIA STUDY-GROUP

Background: Repair of congenital diaphragmatic hernia (CDH) has change d from an emergent procedure to a delayed procedure in the last decade . Many other aspects of management have also evolved since the first s uccessful repair. However, most reports are from single institutions. The lack of a large multicenter database has hampered progress in the management of congenital diaphragmatic hernia (CDH) and makes determin ation of the current standard difficult. Methods: The CDH study group was formed in 1995 to collect data from multiple institutions in North America, Europe, and Australia. Participating centers completed a reg istry form on all live-born infants with CDH during 1995 and 1996. Dem ographic information, data about surgical management, and outcome were collected for all patients. Results: Sixty-two centers participated, with 461 patients entered. Overall survival was 280 of 442 patients (6 3%) where survival was recorded. The defect was left-sided in 78%, rig ht-sided in 21%, and bilateral in 1%. A subcostal approach was used in 91% of patients, with pleural drainage used in 76%. A patch of some k ind was used in just over half (51%) of the patients, with polytetrafl uoroethylene being the most commonly used material (81%) in those pati ents with a patch. The mean surgical time was 102 minutes, with an ave rage blood loss of 14 mL (range, 0 to 500 mL). The overwhelming majori ty of patients underwent repair between 6:00 AM and 6:00 PM (289 of 32 9, 88%). Ninteen percent of patients had surgical repair on extracorpo real membrane oxygenation (ECMO) at a mean time of 170 hours into the ECMO course (range, 10 to 593 hours). The mean age at surgery in patie nts not treated with ECMO was 73 hours (range, 1 to 445 hours). Conclu sions: The multicenter nature of this report makes it a snapshot of cu rrent management. The data would indicate that prosthetic patching of the defect has become common, that after-hours repair is infrequent, a nd that delayed surgical repair has become the preferred approach in m any centers. Furthermore, the mean survival rate of 63% indicates that despite decades of individual effort, the CDH problem is far from sol ved. This highlights the need for a centralized database and cooperati ve multicenter studies in the future. J Pediatr Surg 33:1004-1009. Cop yright (C) 1998 by W.B. Saunders Company.