Systematic review

Unclassified

Hight diaphragmatic hernia with hepatothorax: case report and literature review

Year 2009
Journal ABCD arq. bras. cir. dig
Links Virtual Health Library

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INTRODUCTION:

Traumatic diaphragm lesions still remain problematic in diagnosis and handling.

CASE REPORT:

Patient with diaphragmatic hernia had the diagnosis made three years after car accident. At admission, he was with abdominal pain and respiratory distress. Submitted to image investigation, had the diagnosis done of a diaphragm herniation. Laparotomy revealed liver and adjacent viscera into the thorax and a diaphragm defect of 15 cm. The defect was closed without the use any mash. There was no complications and in an outclinic assistance, one year later, he was asymptomatic.

CONCLUSION:

Diaphragmatic herniations are rare entities. Image examination is indicated and can do correct diagnosis in all cases. Laparotomy or thoracotomy must be use in defect reparation.

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Systematic review

Unclassified

Late-presenting congenital diaphragmatic hernia in children: a literature review.

Year 2005
Authors Bagłaj M , Dorobisz U
Journal Pediatric radiology
Links DOI , Pubmed

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This is a review of 122 articles published until December 2003 that describe 349 children with late-presenting postero-lateral congenital diaphragmatic hernia (CDH). Data regarding pre-operative diagnostic work-up were adequately reported in 177 patients with left CDH and in 41 with a right-sided defect. Chest radiography was the only diagnostic study in 92 (51.9%) children from the former group and in 17 (43.9%) from the latter group. In other patients, diagnostic work-up encompassed various combinations of two or more imaging modalities. Apart from chest radiography, contrast study of the upper gastrointestinal tract was the most frequently performed imaging modality. In 88 (25.2%) children, initial radiographic features of CDH were misinterpreted. Pneumothorax and pleural effusion were the most common initial findings. Analysis of the hernial content in this group of patients has shown that herniation of the stomach, spleen or omentum should be regarded as risk factors for misdiagnosis of left CDH, whereas for right CDH, the risk factor is the presence of liver in the chest. Late-presenting CDH may pose a significant diagnostic problem because of the great variability of radiographic appearance. Chest radiography following passage of a nasogastric tube and contrast studies of the gastrointestinal tract seem to be the most useful investigations for the diagnosis of left CDH. For patients with right CDH, owing to the high probability of liver herniation, a chest radiograph with liver scintigraphy or CT seems to be the best diagnostic option.

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Systematic review

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Mortality factors in infants with congenital diaphragmatic hernia: A systematic review.

Year 2018
Authors Vieira R , Pearse R , Rankin J
Journal Birth defects research
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BACKGROUND:

Congenital diaphragmatic hernia (CDH) is a malformation of the diaphragm accounting for 8% of all major congenital anomalies. Although many clinical factors of survival in children with CDH have been established, limited research exists on the role of sociodemographic and other factors. We aimed to systematically identify and summarize all available international literature, published from January 2000 to July 2017, evaluating specific mortality factors for children with prenatally diagnosed, isolated, left-sided CDH.

METHODS:

MEDLINE, PROSPERO, EMBASE, Scopus, The Cochrane Library databases, and the table of contents for the past 5 years for relevant journals were searched systematically. The risk factors of interest were as follows: birth weight, gestational age (GA) at diagnosis, GA at birth, infant sex, maternal age, ethnicity, socioeconomic status (SES), and plurality. The primary outcome measure was survival. Data were extracted on study design, study quality, participant data, and survival-related effect estimates.

RESULTS:

Seven studies fulfilled the inclusion criteria. In total, 347 children were included in the review. Birth weight, GA at diagnosis, and GA at birth were evaluated in five studies each, infant sex in two, and maternal age in one. None of these factors were significantly associated with survival. No studies evaluated the influence of plurality, ethnicity or SES.

CONCLUSION:

Although the factors of interest showed no significant association with survival, more evidence is required to confirm these findings. Understanding whether sociodemographic factors are associated with survival may help inform the development of public health interventions to improve survival rates for children with CDH.

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Systematic review

Unclassified

Prevalence and risk factors for congenital diaphragmatic hernia: A global view.

Year 2020
Journal Journal of pediatric surgery
Links DOI , Pubmed

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PURPOSE:

To determine the global prevalence for congenital diaphragmatic hernia (CDH) and identify CDH-related risk factors.

METHODS:

Using a defined strategy, a systematic review of the literature was conducted according to PRISMA guidelines, searching for population-based epidemiological studies to evaluate the prevalence of CDH globally and per country. Studies containing overlapping populations or timeframes were excluded. CDH-related risk factors were calculated by meta-analysis using RevMan5.3 and expressed as risk ratio and 95% confidence interval.

RESULTS:

Prevalence: Of 8230 abstracts screened, 30 full-text articles published between 1980 and 2019 were included. The overall prevalence of CDH was 2.3 in 10,000 births (16,710 CDH babies in 73,663,758 livebirths).

RISK FACTORS:

From 9 studies we found that male sex [RR 1.38 (1.05-1.80), p=0.02] and maternal age >35 years [RR 1.69 (1.26-2.25), p=0.0004] were associated with CDH. Conversely, maternal black ethnicity resulted as a protective factor [RR 0.82 (0.77-0.89, p<0.00001].

CONCLUSION:

This study reveals that there is a worldwide paucity of population-based studies, and those studies that report on prevalence and risk factors come from a small number of countries. The prevalence of CDH varies within and across geographical world regions. The main risk factors for CDH identified are male sex and older maternal age. More epidemiological studies, involving more world regions, are needed to identify possible strategies to help strengthen our understanding of the risk factors, provide clinicians with the tools necessary for prenatal and postnatal counseling, and inform policy makers on how to strategize CDH care in different parts of the world.

TYPE OF STUDY:

Systematic review and meta-analysis.

LEVEL OF EVIDENCE:

Level III.

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Systematic review

Unclassified

Core outcome set for perinatal interventions for congenital diaphragmatic hernia.

Year 2023
Journal Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Links DOI , Pubmed
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OBJECTIVE:

To develop a core set of prenatal and neonatal outcomes for clinical studies on perinatal interventions for congenital diaphragmatic hernia, using a validated consensus-building method.

METHODS:

An international steering group (n=13) comprised of leading maternal-fetal medicine specialists, neonatologists, pediatric surgeons, patient representatives, researchers and methodologists guided the development of this core outcome set. Potential outcomes were collected through a systematic review and entered into a two-round online Delphi survey. A call was made for stakeholders with experience with the condition, to review the list and score outcomes based on their perceived relevance. Outcomes that fulfilled the a priori defined consensus criteria were subsequently discussed in online breakout meetings. Results were reviewed in a consensus meeting during which the core outcome set was defined. Finally, the definitions, measurement methods and aspirational outcomes were defined in online and in person definition meetings with a selection from the stakeholders (n=45).

RESULTS:

Two hundred and twenty stakeholders participated in the Delphi-survey and 198 completed both rounds. Fifty outcomes met the consensus criteria and were discussed and rescored by 78 stakeholders in the breakout meetings. During the consensus meeting, 93 stakeholders agreed eventually on eight outcomes constituting the core outcome set. Maternal and obstetric outcomes included maternal morbidity related to the intervention and gestational age at delivery. Fetal outcomes included intra-uterine demise, interval between intervention and delivery and change in lung size in utero around the time of the intervention. Neonatal outcomes included neonatal mortality, pulmonary hypertension and use of extracorporeal membrane oxygenation. Additionally, definitions, measurement methods and three aspirational outcomes were added by 45 stakeholders: duration of invasive ventilation, duration of oxygen supplementation and pulmonary vasodilators at discharge.

CONCLUSIONS:

We developed with relevant stakeholders a core outcome set for studies on perinatal interventions in CDH. Its implementation will facilitate comparison, contrasting and combination of trial results, enabling research to guide clinical practice. This article is protected by copyright. All rights reserved.

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Primary study

Unclassified

Congenital diaphragmatic hernia

Year 2021
Authors Boonthai, A. , Losty, P.D.
Journal ERS Monograph
Links DOI

This article is not included in any systematic review

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Systematic review

Unclassified

Maternal diaphragmatic hernia in pregnancy: A systematic review with a treatment algorithm.

Year 2023
Journal World journal of clinical cases
Links PMC , DOI , Pubmed

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BACKGROUND:

Diaphragmatic hernia (DH) is extremely rarely described during pregnancy. Due to the rarity, there is no diagnostic or treatment algorithm for DH in pregnancy.

AIM:

To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature.

METHODS:

Literature search of English-, German-, Spanish-, and Italian-language articles were performed using PubMed (1946-2021), PubMed Central (1900-2021), and Google Scholar. The PRISMA protocol was followed. The search terms included: Maternal diaphragmatic hernia, congenital hernia, pregnancy, cardiovascular collapse, mediastinal shift, abdominal pain in pregnancy, hyperemesis, diaphragmatic rupture during labor, puerperium, hernie diaphragmatique maternelle, hernia diafragmática congenital. Additional studies were identified by reviewing reference lists of retrieved studies. Demographic, imaging, surgical, and obstetric data were obtained.

RESULTS:

One hundred and fifty-eight cases were collected. The average maternal age increased across observed periods. The proportion of congenital hernias increased, while the other types appeared stationary. Most DHs were left-sided (83.8%). The median number of herniated organs declined across observed periods. A working diagnosis was correct in 50%. DH type did not correlate to maternal or neonatal outcomes. Laparoscopic access increased while thoracotomy varied across periods. Presentation of less than 3 days carried a significant risk of strangulation in pregnancy.

CONCLUSION:

The clinical presentation of DH is easily confused with common chest conditions, delaying the diagnosis, and increasing maternal and fetal mortality. Symptomatic DH should be included in the differential diagnosis of pregnant women with abdominal pain associated with dyspnea and chest pain, especially when followed by collapse. Early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes. A proposed algorithm helps manage pregnant women with maternal DH. Strangulated DH requires an emergent operation, while delivery should be based on obstetric indications.

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Broad synthesis / Living FRISBEE

Unclassified

Early versus late surgical correction in congenital diaphragmatic hernia.

Year 2017
Authors Yunes A , Luco M , Pattillo JC
Journal Medwave
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INTRODUCTION:

The timing of surgical repair in patients with congenital diaphragmatic hernia has been a controversial topic over the years, and there is still no agreement as to whether immediate repair or late surgery with preoperative stabilization is preferable.

METHODS:

To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach.

RESULTS AND CONCLUSIONS:

We identified four systematic reviews including 38 studies overall, of which two were randomized trials. We concluded it is not clear whether immediate surgical repair in congenital diaphragmatic hernia increases mortality or decreases hospitalization days compared to late repair because the certainty of evidence is very low.

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Systematic review

Unclassified

Minimally invasive surgery for congenital diaphragmatic hernia: a meta-analysis.

Year 2016
Authors Zhu Y. , Wu Y. , Pu Q. , Ma L. , Liao H. , Liu L.
Journal Hernia
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OBJECTIVES:

To compare the safety and efficacy of minimally invasive surgery (MIS) with traditional open surgical approach for congenital diaphragmatic hernia (CDH).

METHODS:

A literature search was performed using the PubMed database, Embase, and the Cochrane central register of controlled trials using a defined set of criteria. The outcomes, which include post-operative mortality, incidence of hernia recurrence, rates of patch use and complications, were analyzed.

RESULTS:

We investigated nine studies, which included 507 patients. All studies were non-randomized historical control trials. The MIS group had a significantly lower rate of post-operative death with a risk ratio of 0.26 [95% confidence interval (CI) 0.10-0.68; p = 0.006] but a greater incidence of hernia recurrence with a risk ratio of 3.42 (95% CI 1.98-5.88; p < 0.00001). Rates of prosthetic patch use were similar between the two groups. Fewer cases of surgical complications were found in the MIS group with a risk ratio of 0.66 (95% CI 0.47-0.94; p = 0.02).

CONCLUSIONS:

MIS for CDH repair is associated with lower post-operative mortality and morbidity compared with traditional open repair. Although rate of patch use appears to be comparable, the increased risk of CDH recurrence should not be ignored. The lack of well-controlled prospective trials still limits strong evaluations of the two surgical techniques.

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Systematic review

Unclassified

Congenital diaphragmatic hernia-does the presence of a hernia sac improve outcome? A systematic review of published studies.

Year 2020
Authors Raitio A , Salim A , Losty PD
Journal European journal of pediatrics
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Early reports have suggested survival benefits associated with a hernia sac in congenital diaphragmatic hernia (CDH). However, these studies have included only small subsets of patients. This systematic review aimed to evaluate differences in outcomes of CDH newborns with and without a hernia sac. PubMed and Embase databases were searched using relevant key terms. Papers were independently reviewed by two authors with final selection approved by the senior author. Original search retrieved 537 papers; the final review included 8 studies (n = 837 patients). There were 168 CDH patients (20%) with a hernia sac with an overall survival of 93% vs 73% for CDH newborns without a sac (p < 0.001). Twenty-three percent of patients with a CDH sac required diaphragm patch repair vs 44% patients without a sac (p < 0.001). Pulmonary hypertension was manifested in 44% of CDH babies with a hernia sac vs 64% without a sac (p < 0.001). Three studies compared ECMO requirement: 15% with a hernia sac and 34% without sac, p < 0.001.Conclusion: This study shows significant survival benefits in newborns associated with presence of a CDH sac. This may be likely related to these infants having more favourable physiology with less severe pulmonary hypertension and/or smaller anatomical defects requiring primary closure only. What is Known: • Early reports have suggested survival benefits associated with a hernia sac in CDH. • Previous studies have included only a small number of patients. What is New: • A systematic review of published studies clearly shows that CDH newborns with a hernia sac have better overall survival outcomes and less severe pulmonary hypertension. • ECMO utilization and patch repair were also less often required in newborns with a hernia sac.

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