Gastroesophageal reflux and diaphragmatic motility after repair of congenital diaphragmatic hernia

At the Department of Pediatric Surgery in Graz, 31 boys and 23 girls were o perated on for congenital diaphragmatic hernia (CDH) from 1978 to 1994. In 49 patients the defect was on the left, in five on the right side. In 46 ca ses, the hernia was diagnosed within the first week of life; in eight child ren at a later date. 19 children (35%) died. 25 of the 35 survivors (71%) c ame to a follow-up examination on average 9.4 (1-17) years after the operat ion. 24 h pH-monitoring or manometry and Upper G.I. series revealed patholo gical gastroesophageal reflux (GER) in 16 patients. Nine children were trea ted conservatively; in seven patients an antireflux procedure was performed . A thoracic position of the stomach or left liver lobe, presence of a hern ial sac, gestational age, prenatal diagnosis, use of a patch or severity of lung hypoplasia did not significantly influence the incidence of CER. In t hree patients, a hiatal hernia was found. The motility of the diaphragm was documented with M-mode sonography (n = 18); a restricted motility could be demonstrated in five patients. GER is very common in patients after repair of CDH. We recommend long-term follow-up with special interest in respect of GER.