Technology assessment for management of congenital diaphragmatic hernia: immediate versus delayed surgery.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in pediatric surgery, especially in neonates with symptom presentation within 6 hours after birth. Opinion regarding the time of surgery has gradually shifted from immediate repair to a policy of stabilization and delayed repair. Whether delayed surgery is beneficial remains controversial. OBJECTIVE: To evaluate the outcomes regarding whether delayed surgical repair improves survival in CDH neonates, who are symptomatic immediately after delivery, is more beneficial than immediate surgery. MATERIAL AND METHOD: Data were obtained by searching MEDLINE (1966-2002) and the Cochrane Database, Issue 2, 2003 using the term "congenital diaphragmatic hernia" and "surgery". Inclusion criteria were randomized controlled trial (RCT), prospective trial (PT), retrospective analysis (RA) and meta-analysis (MA). Information from the literature was analyzed by the computer program of Epi Info Version 3. Statistical significance was reliable at the level of p < 0.05. RESULTS: Twenty-five studies were obtained and RCT/RA was 2/23. Analysis of results of CDH management revealed that pre-operative stabilization and delayed surgery improved the survival rate in 14 of 25 in the literature (p < 0.05), while the remaining 11 articles showed no statistical difference of survival between immediate and delayed surgery (p > 0.05). CONCLUSION: From the evidence-based analysis, the results of CDH management between immediate versus delayed surgery were unclear. From the reviewer's experience at the Queen Sirikit National Institute of Child Health, the strategy of pre-operative stabilization and delayed surgery had better improved survival of CDH than immediate surgery.