Systematic review

Unclassified

Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature.

Year 2015
Journal Hernia : the journal of hernias and abdominal wall surgery
Links DOI , Pubmed

Without references

Loading references information
Show abstract

BACKGROUND:

Diaphragmatic hernia (DH) after esophagectomy is a known complication which can occur and the incidence may be higher after minimally invasive esophagectomy (MIE). A review of our cases involving post-MIE diaphragmatic hernias and the published literature is presented.

METHODS:

A retrospective review of patients who underwent MIE from November 2006 to January 2013 was performed. An Embase and Pub Med literature search on diaphragmatic hernia post-esophagectomy was conducted from 1990 to 2013 and reviewed.

RESULTS:

In total, 120 consecutive patients underwent MIE at our institution. Neoadjuvant chemoradiotherapy had been performed in 71.4 % of patients. The mean age was 65 ± 22 years and 85 % were male. Seven patients (5.8 %) were diagnosed with DH by radiographic imaging with 5 (71.4 %) requiring surgical intervention. Diagnosis was made at a median time of 3.4 months (range 1-45 months) after MIE. One patient recurred after repair and underwent a second repair. There were no related mortalities. In literature review, 11 publications reporting DH were reviewed documenting a total of 4669 esophagectomies, with 756 MIE. The incidence of DH observed was 121 (2.6 %) in all patients and 34 (4.5 %) in MIE. Two studies comparing open versus MIE also reported a higher incidence of DH in MIE.

CONCLUSIONS:

Post-esophagectomy diaphragmatic hernia can occur and may be underreported. Minimally invasive esophagectomy appears to have a higher incidence of postoperative herniation when compared to traditional, open esophagectomy.

Show abstract

Primary study

Unclassified

Prognosis of congenital diaphragmatic hernia.

Year 1998
Authors Moore A , Umstad MP , Stewart M , Stokes KB
Journal The Australian & New Zealand journal of obstetrics & gynaecology
Links DOI , Pubmed

This article is included in 1 Systematic review Systematic reviews (1 reference)

Loading references information
Show abstract

Congenital diaphragmatic hernia (CDH) contributes significantly to perinatal morbidity and mortality. This retrospective study examines the experience of a major teaching hospital to establish survival rates and factors influencing outcome. Survival rates were found to relate closely to the stage at which the diagnosis was made and the presence of associated anomalies. Ultrasound diagnosis early in pregnancy is associated with a higher mortality rate than diagnosis made late in pregnancy or after delivery. Logistic regression analysis and chi-squared analysis did not establish to a significant degree that any factor, alone or in combination, was a reliable prognostic indicator. It is acknowledged, however, that figures in this series are small. Survival figures are presented to facilitate reliable parental counselling. In particular, the presence of associated major anomalies and the gestational age at which diagnosis is made are of critical importance in accurately counselling parents regarding the prognosis for survival. In this study, excluding terminations, the mortality rate for isolated CDH diagnosis before the 21st week was 45.5%, with a corresponding survival rate of 54.5%. Once the infant was liveborn, however, the survival rate rose to 68.0%, and if the infant survived transfer to a paediatric surgical unit, the survival rate in this study was 73.9 %.

Show abstract

Primary study

Unclassified

Congenital diaphragmatic hernia in the newborn

Year 1992
Authors Rasheed , K. , Coughlan , G. , & O’Donnell , B.
Journal Irish journal of medical science
Links
Loading references information
Show abstract

This article has no abstract

Show abstract

Systematic review

Unclassified

Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH).

Year 2017
Journal Journal of Pediatric Surgery
Links DOI , Pubmed

Without references

Loading references information
Show abstract

BACKGROUND:

Pulmonary hypoplasia is the main cause of mortality in isolated congenital diaphragmatic hernia (CDH) and its prediction is paramount when counseling parents. We sought to identify antenatal parameters that predicted neonatal mortality in CDH.

METHOD:

Search was conducted in MEDLINE, EMBASE, Cochrane Database of Systematic reviews, PubMed, Scopus, and Web of Science on the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e LHR), total fetal lung volume (TFLV), o/e TFLV, percentage predicted lung volume (PPLV) and degree of liver herniation to predict neonatal morbidity and mortality in fetuses with CDH. Primary outcome was perinatal survival and secondary was the use of extracorporeal membrane oxygenation (ECMO).

RESULTS:

Until April 2016, 1067 articles were found, of which 22 were included in our meta-analysis. This showed that the odds of survival with LHR <1.0 and liver herniation on ultrasound were 0.14 (CI 0.10-0.27) and 0.21 (CI 0.13-0.35) respectively. Mean LHR, o/e LHR, absolute TFLV, o/e TFLV, PPLV and liver herniation all predicted survival, however o/e LHR and o/e TFLV performed best in this prediction. When the longest diameter measurement method was used, the o/e TFLV (summary area under curve (AUC) 0.8) was slightly superior to o/e LHR (summary AUC 0.78). This difference disappeared when LHR was measured by the trace method. The most discriminatory threshold for O/E LHR and O/E TFLV was 25%. LHR <1 was predictive of extracorporeal life support (ECLS) use.

CONCLUSION:

O/E LHR, o/e TFLV (thresholds of 25%) and liver herniation are good predictors of mortality in CDH.

LEVEL OF EVIDENCE:

Level II Type of study: Systematic review and meta-analysis.

Show abstract

Systematic review

Unclassified

A Systematic Review Examining the Experimental Methodology Behind In Vivo Testing of Hiatus Hernia and Diaphragmatic Hernia Mesh.

Year 2021
Journal Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Links DOI , Pubmed

Without references

Loading references information
Show abstract

INTRODUCTION:

Mesh implants are regularly used to help repair both hiatus hernias (HH) and diaphragmatic hernias (DH). In vivo studies are used to test not only mesh safety, but increasingly comparative efficacy. Our work examines the field of in vivo mesh testing for HH and DH models to establish current practices and standards.

METHOD:

This systematic review was registered with PROSPERO. Medline and Embase databases were searched for relevant in vivo studies. Forty-four articles were identified and underwent abstract review, where 22 were excluded. Four further studies were excluded after full-text review-leaving 18 to undergo data extraction.

RESULTS:

Of 18 studies identified, 9 used an in vivo HH model and 9 a DH model. Five studies undertook mechanical testing on tissue samples-all uniaxial in nature. Testing strip widths ranged from 1-20 mm (median 3 mm). Testing speeds varied from 1.5-60 mm/minute. Upon histology, the most commonly assessed structural and cellular factors were neovascularisation and macrophages respectively (n = 9 each). Structural analysis was mostly qualitative, where cellular analysis was equally likely to be quantitative. Eleven studies assessed adhesion formation, of which 8 used one of four scoring systems. Eight studies measured mesh shrinkage.

DISCUSSION:

In vivo studies assessing mesh for HH and DH repair are uncommon. Within this relatively young field, we encourage surgical and materials testing institutions to discuss its standardisation.

Show abstract

Systematic review

Unclassified

Neurodevelopmental impairment in children with congenital diaphragmatic hernia: Not an uncommon complication for survivors.

Year 2019
Journal Journal of pediatric surgery
Links DOI , Pubmed

Without references

Loading references information
Show abstract

PURPOSE:

To evaluate neurodevelopmental impairment (NDI) in children born with congenital diaphragmatic hernia (CDH).

METHODS:

Using a defined search strategy, a systematic review was conducted to define the incidence and types of NDI, to report abnormal neuroimaging findings and to evaluate possible NDI predictors. Ameta-analysis was performed on comparative studies reporting risk factors for NDI, using RevMan 5.3.

RESULTS:

Of 3541 CDH children (33 studies), 829 (23%) had NDI, with a higher incidence in CDH survivors who received ECMO treatment (49%) vs. those who had no ECMO (22%; p<0.00001). NDI included neuromuscular hypotonia (42%), hearing (13%) and visual (8%) impairment, neurobehavioral issues (20%), and learning difficulties (31%). Of 288 survivors that had postnatal neuroimaging, 49% had abnormal findings. The main risk factors for NDI were severe pulmonary hypoplasia, large defect size, ECMO use.

CONCLUSIONS:

NDI is a relevant problem for CDH survivors, affecting 1 in 4. The spectrum of NDI covers all developmental domains and ranges from motor and sensory (hearing, visual) deficits to cognitive, language, and behavioral impairment. Further studies should be designed to better understand the pathophysiology of NDI in CDH children and to longitudinally monitor infants born with CDH to correct risk factors that can be modifiable.

LEVEL OF EVIDENCE:

Level III.

Show abstract

Primary study

Unclassified

[Traumatic diaphragmatic hernia in children].

Year 1987
Journal Anales espanoles de pediatria
Links Pubmed

This article is not included in any systematic review

Loading references information
Show abstract

We have treated three children with traumatic diaphragmatic hernia appearing after blunt abdominal trauma. The hernia was on the right side in two patients and was accompanied by liver and lung injuries. The most common site of diaphragmatic rupture was the postero-lateral area in both sides. Diagnosis was suspected in all of them with chest radiograph before operative management. The transabdominal approach has proven to be efficacious in repairing the defects and often require emergency care. The diaphragmatic repair was performed using non absorbable interrupted mattress sutures. No prosthetic materials were required.

Show abstract

Primary study

Unclassified

Prognosis in fetal diaphragmatic hernia.

Year 1992
Journal American journal of obstetrics and gynecology
Links DOI , Pubmed

This article is included in 1 Systematic review Systematic reviews (1 reference)

Loading references information
Show abstract

The reported mortality for prenatally detected congenital diaphragmatic hernia is high. Polyhydramnios and presentation in early pregnancy have been suggested as high-risk factors adversely affecting outcome. We retrospectively reviewed 55 cases of congenital diaphragmatic hernia diagnosed prenatally in our unit. There was an overall mortality of 73%. The mortality in cases with presentation before 25 weeks' gestation was 74%, if the cases resulting in termination of pregnancy are excluded, compared with a mortality of 60% in those seen after this gestational age. Underdevelopment of left-sided cardiac structures was found to be a helpful prognostic factor. We were unable to confirm the predictive nature of hydramnios. Associated chromosomal anomalies were found in two fetuses and major congenital heart disease in nine. Although diagnosis before 25 weeks' gestation is associated with a higher mortality than in cases detected later, it is not universally fatal. If congenital heart disease and chromosomal anomalies are excluded and there is little or no evidence of left heart underdevelopment, the odds for survival will improve. This should be taken into account when the management of these cases is planned.

Show abstract

Systematic review

Unclassified

Recurrence of anterior congenital diaphragmatic hernia after laparoscopic repair in children.

Year 2024
Journal Pediatr. Surg. Int.
Links DOI , Pubmed

Without references

Loading references information
Show abstract

PURPOSE:

To report our experience with laparoscopic repair of anterior congenital diaphragmatic hernia (CDH) using extracorporeal subcutaneous knot tying and to define recurrence risk factors.

METHODS:

This retrospective unicentric study included children who underwent laparoscopic repair of anterior CDH without patch, using extracorporeal knot tying of sutures passed through the full thickness of the abdominal wall (2013-2020). A systematic review of the literature with meta-analysis was performed using the MEDLINE database since 2000.

RESULTS:

Eight children were included (12 months [1-183]; 10.6 kg [3.6-65]). Among the two patients with Down syndrome, one with previous cardiac surgery had a recurrence at 17 months postoperatively. In our systematic review (26 articles), among the 156 patients included, 10 had a recurrence (none with patch). Recurrence was statistically more frequent in patients with Down syndrome (19.4%) than without (2.5%) (p < 0.0001), and when absorbable sutures were used (50%) instead of non-absorbable sutures (5.3%) (p < 0.0001).

CONCLUSION:

Laparoscopic repair of anterior CDH without patch was a safe and efficient surgical approach in our patients. The use of a non-absorbable prosthetic patch should be specifically discussed in anterior CDH associated with Down syndrome and/or in case of previous cardiac surgery to perform a diaphragmatic tension-free closure.

Show abstract

Systematic review

Unclassified

Optimal early surgery timing for congenital diaphragmatic hernia: A systematic review

Year 2024
Journal The Medical journal of Malaysia
Links Pubmed

Without references

Loading references information
Show abstract

INTRODUCTION:

Congenital diaphragmatic hernia (CDH) is a failure of closure of the pleuro-peritoneal canal due to faulty embryogenesis caused herniation of intra-abdominal contents into the chest. There needs to be more clarity about the optimal surgical timing for CDH. The aim of this study is to determine the optimal surgical timing for CDH using a systematic review analysis.

MATERIALS AND METHODS:

Our study used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. The literature search approach used publications between 2013 and 2023 using Pubmed and SagePub databases. Studies were included if they contained reports of the best timing for emergency surgery for CHD repair. We did not include review articles and unpublished data.

RESULTS:

Five articles met the criteria. The overall result, the first pre-operative 24-hour oxygenation index mean, was temporally reliable and representative (intraclass correlation coefficient = 0.70, 95% CI = 0.61-0.77). Within any severity level, there were no differences in 90-day survival or mortality rate between delayed repair and early repair (p = 0.002). As a result, there is no optimal timing for surgery in severe cases of CDH. A delay in repair did not predict an increased risk of death, nor did it suggest an increased need for post-operative extracorporeal membrane oxygen therapy.

CONCLUSION:

Regardless of the severity of the illness, the timing of CDH repair does not affect the mortality rate.Surgery is done after the physiology index achievement.

Show abstract