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Annals of Emergency Surgery
Research Article *Corresponding author
Kim Heiwegen, Department of Pediatric Surgery,

Short Term Surgical Outcomes Radboudumc – Amalia Children’s Hospital, route 618,
PO box 9101, 6500 HB Nijmegen, the Netherlands,
Phone: 31-24-361-97 61; Fax: 31-24-361-35-47; Email:

in the Treatment of Congenital Submitted: 27 December 2016

Diaphragmatic Hernia:
Accepted: 24 January 2017
Published: 26 January 2017
Copyright

An Overview of 15 Years © 2017 Heiwegen et al.

OPEN ACCESS

Experience Keywords
• Congenital diaphragmatic hernia
Kim Heiwegen1*, Ivo de Blaauw1, Stan Janssen1, Iris ALM van • Treatment
• Surgery
Rooij2, Arno van Heijst3, and Sanne MBI Botden1
• Outcomes
1
Department of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, The
Netherlands
2
Department of Health Evidence, Radboud Institute for Health Sciences, The
Netherlands
3
Department of Neonatology, Radboudumc-Amalia Children’s Hospital, The
Netherlands

Abstract
Introduction: Congenital diaphragmatic hernia (CDH) is characterized by a defect of the diaphragm, pulmonary hypoplasia and pulmonary hypertension.
Data on surgical outcome are scarce since pulmonary function seems to predominate the outcome. This study gives an overview of recent short term surgical
outcomes of a large single center cohort.
Method: All CDH patients treated in a high volume centre, from 2000-2015, were retrospectively evaluated. Surgical outcome was described. Furthermore,
demographics, patient and CDH characteristics and treatments were registered. Differences in these parameters between survivors and non-survivors were
analyzed.
Results: In total 215 patients were included, with a 1-year mortality rate of 27%. Of the 197 repaired patients, 40% needed patch repair. In most
patients the abdominal fascia could be closed after the repair (77%), however in 15% an abdominal patch was needed, because both the fascia and skin could
not be closed. In total 31% of the patients had surgical complications, of which 14% hemorrhage postoperative, 17% chylothorax and recurrence occurred in
6% within one year/ recurrence showed no statistical difference between primary and patch repair (p=1.00). No patch infections were encountered. Surgical
hemorrhage and chylothorax were encountered significantly more in non-survivors compared to survivors (30% versus 5%, p=< 0.001, 28% versus 14%,
p=0.04, respectively). An abdominal patch was needed in 28% of non-survivors and 8% of survivors (p< 0.001).
Conclusion: This overview shows the incidence of surgical short term outcome in a high volume center. Survivors had a significant lower incidence of surgical
complications and had a relatively low recurrence rate within one year (6%).

ABBREVIATIONS vasculature, also by pulmonary hypertension [1,3,4]. Pulmonary

CDH: Congenital Diaphragmatic Hernia; CDHSG: CDH Study
Group; DOL: Days of Life; ECMO: Extra Corporeal Membranous
Oxygenation; FETO: Fetal Endoscopic Tracheal Occlusion; NICU:
Neonatal Intensive Care Unit; NO: Nitric Oxide; PTFE: Poly Tetra
Fluoro Ethylene
INTRODUCTION
Congenital diaphragmatic hernia (CDH) is a possible lethal
birth defect, which occurs in approximately 1:2000-3000 live
births [1,2]. The defect is caused by improper developed diaphragm
and lungs during embryogenesis, allowing abdominal viscera to
protrude into the thorax. CDH is furthermore characterized by
pulmonary hypoplasia and, due to maldevelopment of the lung
problems remain the most challenging issue in the treatment
of CDH patients and can lead to lethal persistent pulmonary
hypertension in the neonatal period and chronic lung problems
later in life [5]. Over the last decades, modern medical advances
have led to modest improvements in perinatal care [1,6]. These
advances not only include improvements in antenatal care, such
as fetal endoscopic tracheal occlusion (FETO), but also better
techniques to stabilize newborns with CDH after birth, using
gentle ventilation techniques and extracorporeal membranous
oxygenation (ECMO) [7-9]. Because of these advances in
treatment, more neonates survive nowadays (70-80%), but
possibly at the cost of more morbidity [1]. The clinical course of
CDH still remains unpredictable in many cases despite intensive
monitoring and extensive analysis of patient data [6].

Cite this article: Heiwegen K, de Blaauw I, Janssen S, van Rooij IALM, van Heijst A, et al. (2017) Short Term Surgical Outcomes in the Treatment of Congenital
Diaphragmatic Hernia: An Overview of 15 Years Experience. Ann Emerg Surg 2(1): 1005.

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Surgery seems to be of less influence on the outcome and
surgical outcome data have been less extensively analyzed. There
are still ongoing discussions concerning several key aspects of
the surgical repair. This includes exact timing of repair, when to
use a patch and what type of patch is best in a large defect (e.g.
synthetic or biodegradable) and its influence on morbidity and
final outcome [6,10]. Moreover, surgical treatment strategies
vary widely in the diverse CDH treating centers. Therefore,
different studies and experiences are required to identify best
treatment interventions and their outcomes. This study gives an
overview of 15 years experience of short term surgical outcomes
of neonates with a CDH treated in a Dutch high volume center.
MATERIALS AND METHODS
All patients diagnosed with a CDH and treated in the high
volume center of the Radboudumc – Amalia Children’s hospital,
Nijmegen, the Netherlands, between January 1, 2000 and
December 31, 2015 were included in this study. The electronic
and scanned patient files were reviewed for multiple parameters.
Demographics, perinatal parameters, patient characteristics and
CDH characteristics, such as side and size of the defect, position of
the liver, chromosomal anomalies, and other birth defects were
collected. Pulmonary hypertension was diagnosed using cardiac
ultrasound. Cardiac malformations were classified as major,
when hemodynamic effects occurred or needed treatment, as
stated by CDH Study Group (CDHSG) [11].
Primary outcomes of this study were surgical outcomes,
including hemorrhage, chylothorax, patch infections and
recurrence rate of CDH within one year. Secondary outcomes
were survival up to the age of one, the need for extracorporeal
membrane oxygenation (ECMO), duration of stay at the neonatal
intensive care unit (NICU), total hospital stay in this high volume
center and the number of surgeries performed in the first year of
life. Prenatally diagnosed neonates with CDH were delivered at
the Radboudumc and transported to the NICU immediately after
birth. Out born patients or patients diagnosed postnatally were
transported to the NICU of this center shortly after diagnosis.
The neonates were managed according to the standard care for
CDH patients at the time of presence [12]. ECMO was offered
to patients with severe respiratory failure and pulmonary
hypertension when standard therapy and ventilation techniques
failed [13].
The repair of CDH was performed by two specialized pediatric
surgeons. A tension-free closure with silk 3-0 was first choice of
surgical closure. Poly tetra fluoro ethylene (Goretex) patch was
used in all cases of patch repair, when the performing surgeon(s)
were in the opinion that the defect could not be closed primarily
without tension. In case of ECMO treatment, the repair was
targeted after stabilization and weaning, but before decanulation.
Defect size was noted according to the CDHSG scale, in which A
is a small defect (< 25% of the hemi diaphragm), B is a defect
including 25-50% of the hemi diaphragm, C a defect of 50-75%
of the hemi diaphragm, and in D most of the hemi diaphragm is
absent (> 75%) [11].
Values are expressed as means and standard deviations,
median with range, or in percentages, when appropriate.
Differences in patient and CDH characteristics, surgical treatment,
Ann Emerg Surg 2(1): 1005 (2017)
Heiwegen et al. (2017)
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complications and outcome between survivors and non-
survivors were tested using the independent student’s T-test or
Mann-Whitney U test for continuous variables and with the chi-
square or Fisher exact tests for categorical data, as appropriate.
A p-value of <0.05 was considered statistically significant. All
statistical analyses were performed using IBM SPSS Statistics 22.
RESULTS AND DISCUSSION
Results
The demographics and patient characteristics of the total
population (n=215) are presented in (Table 1). Of the inborn
patients, 92% was diagnosed prenatally, while only 7% of those
born elsewhere was diagnosed prenatally. FETO was performed
on eleven prenatal diagnosed patients, which is 5% of the total
population. Sizes of the hernias, based on the classification of
the CDH registry group, were most often classified as B or C,
but missing for many. Some patients were also diagnosed with
other anomalies as described in Table 1. The most common
major cardiac malformations encountered were coarctation of
the aorta (n=2), tetralogy of Fallot (n=2) and hypoplastic left
heart syndrome (n=2). Other types of birth defects reported
were dysmorphic features (18%), vertebra anomalies (11%)
and omphalocele (7%). Chromosomal anomalies reported more
than once were chromosomes 7, 11, 17 and X, which were all
diagnosed in two of the thirteen patients.
Direct postnatal treatment interventions for stabilization of
all patients are presented in (Table 2). Pulmonary hypertension
was diagnosed in 97 patients using cardiac ultrasound. This
was most often treated with oxygen therapy and inhaled nitric
oxide (NO). Sixty-six patients needed ECMO to support the
cardiopulmonary system and/or treat persistent pulmonary
hypertension. However fourteen patients had contra-indications
for ECMO treatment and did not survive due to the pulmonary
hypertension. Of the 44 patients with pulmonary hypertension
who were not treated with ECMO, 32% did not survive, compared
to 59% of the 53 patients who were treated with ECMO (p=0.009).
Four patients were canulated on ECMO, however were not
surgically repaired because they did not survive, regardless of
the ECMO treatment.
Of all patients, 197 survived until surgical repair. The median
amount of days between diagnosis and surgical repair was 4
(range: 0-133). A reason for delayed Repair was late diagnosis.
Approximately 60% percent of the surgically repaired patients
could be repaired primarily and almost 40% needed patch
repair. Twelve patients were repaired after 90 days of life, one of
them by patch repair During surgery, the abdominal fascia was
closed in most patients (n=141, 77%), however, this was only
possible in half of the patch repaired patients. When also the skin
could not be closed, an abdominal patch was used, which was
necessary in 34% of the patch repaired patients, compared to 3%
in primary repaired patients (p< 0.001). A chest drain was placed
peri-operative in 58% (n=106) of the patients, which was done in
80% (n=47) of the patients canulated on ECMO compared to 47%
(n=58) of the non ECMO patients (p< 0.001).
The clinical outcomes, including survival and surgical
complications, are presented in (Table 3). The median age of death
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Table 1: Demographics, perinatal, and anomaly characteristics of the Table 3: Main clinical outcomes of the total group congenital
total patient group with congenital diaphragmatic hernia. diaphragmatic hernia patients.
Total group (n=215) Total group
Gender - male, n (%) 133 (61.9) (N=215)
Inborn1, n (%) 120 (58.0) Survival, n (%)
Prenatal diagnosis of CDH2, n (%) 114 (56.2) 30 days survival 170 (79.1)
1 year survival 157 (73.0)
Birth weight in grams3, mean (SD) 2970 (653)
Surgical complications of repaired patients (n=197), 60 (30.5)
Gestational age in weeks4, median 38.3 (27.7-42.7)
n (%)
(range)
Hemorrhage peri-operative 7 (3.6)
Apgar score, median (range) Intraventricular hemorrhage 20(10.2)
1 minute5 6 (0-9) Surgical hemorrhage 33 (16.8)
5 minutes6 8 (0-10) Chylothorax
Side hernia7, n (%) Recurrent hernia of repaired patients (n=197), n (%)
Left 174 (80.9) Within 30 days 1 (0.5)
Right 35 (16.3) Within 1 year 12 (6.1)
Bilateral 5 (2.3)
Diaphragm/ patch infection within 1 year, n (%) 0 (0)
Liver up8 70 (35.4)
Length of stay NICUa, median (range) 15 (0-323)
Size hernia9, n (%)
Length of stay hospital*, median (range)
A 16 (15.2)
All patients 18 (0-329)
B 46 (43.8)
Survivors 20 (3-329)
C 36 (34.3)
D 7 (6.7) Number of surgeries in first year, median (range) 2 (1-12)
Major cardiac malformations10, n (%) 9 (4.2) *Length of stay in this high volume center, including patients referred
to regional hospital
Other birth defects11, n (%) 28 (13.1) a
NICU: Neonatal Intensive Care Unit
Chromosomal anomalies12, n (%) 13 (6.1)
Missing values: 1 8, 2 12, 3 33, 4 37, 5 45, 6 44, 71, 819, 9110, 102, 112, 123
was 15 days (range 0-184) and 78% of the 58 deceased before 30
CDH: Congenital Diaphragmatic Hernia
days of age. Those that deceased after 30 days died mostly due to
cardio respiratory failure and rebound pulmonary hypertension
Table 2: Postnatal treatment characteristics of neonates with congenital (5 versus 4 patients respectively). Those repaired after 90 days
diaphragmatic hernia.
all survived (p=0.13). The mortality rate for patients who got
Total group (N=215)
surgically repaired was 20%. Hemorrhagic complications of
Postnatal treatment repaired patients included intra ventricular (n=7) and surgical
Primary intubated1*, n (%) 137 (73.3)
site hemorrhage (n=20). Of these latter patients, ten had spleen
Duration of ventilation (days), median 10 (1.0-41.8)
injuries and five of them needed splenectomy for this cause.
(5-95% range)
None of those bleedings were fatal. Six patients were obligatory
Pulmonary hypertension2, n (%) 97 (52.4)
weaned from ECMO due to several bleeding complications and
Use of inhaled NO3 (a), n (%) 88 (42.3)
died shortly after decanulation.
ECMOb, n (%) 66 (30.7)
Duration of ECMO (days) 8 (1.0-20.0) Twelve of the 197 repaired patients (6%) had a recurrence of
Surgical treatment the diaphragm defect within one year, of which only one patient
Repaired patients, n (%) 197 (91.6) did not survive due to persistent pulmonary hypertension. There
Method of repair, n (%) was no difference in recurrence rate between primary and patch
Primary 119 (60.4) repaired patients (both 6%, p=1.00). The mean time at which
Patch 78 (39.6) the patients were Reoperated on their recurrent hernias was
Approach of repair4, n (%) 145 days of life (SD 90.3). None of the patients corrected after
Subcostal 169 (88.9) 90 days of life had a recurrence after one year follow up. Because
Thoracotomy 5 (2.6)
the mean time to reoperation was longer than the mean time
Thoracoscopic 12 (6.3)
Laparoscopic 4 (2.1) to death, the recurrence rate was also calculated excluding all
Closure of abdominal wall fascia5, n (%) 141 (76.6) deceased patients (7%, n=11/157).
Abdominal patch6, n (%) 28 (14.6) Table 4 describes the differences in patient and CDH
Chest drain peri-operative7, n (%) 106 (57.6) characteristics, treatment, and surgical complications between
DOLc at surgical repair, median 5 (1.0-148.4) the survivors and non survivors. Apgar scores from patients who
(5-95% range) did not survive were significantly lower than those from patients
Missing values: 18, 230, 37, 410, 47, 513, 65, 713 who did survive (median 5 versus 7 at 1 minute and median 7
*
Of the 215 patients, 189 patients were intubated, which was unknown versus 8 at 5 minutes, respectively). Other significant differences
in 12 patients. 14
in the patient and CDH characteristics that were found more
patients were not intubated at all mostly related to late diagnosis of
CDH (79%). in non-survivors were liver up, pulmonary hypertension and
a
NO: Nitric Oxide; bECMO: Extracorporeal Membranous Oxygenation; chromosomal anomalies. Also inhaled NO and ECMO were used
c
DOL: Days of Life significantly more often (p< 0.001) in this group. Of the primary

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Table 4: Congenital diaphragmatic hernia specific characteristics and outcome in survivors and non survivors.
Survivors Non-survivors
P-value
(n=157) (n=58)
Patient/ CDH specific characteristics
Gender – male, n (%) 96 (61.1) 37 (63.8) 0.72
Inborn, n (%) 77 (51.7) 43 (74.1) 0.03
Prenatal diagnosis1 72 (49.7) 42 (72.4) 0.03
Birth weight in grams, mean (SD)2 3028 (666) 2526 (604) 0.06
Gestational age in weeks, median (range)3 38 (27.7-42.7) 38 (29.1-42.3) 0.07
Apgar score, median (range)
1 minute4 7 (1-9) 5 (0-9) <0.001
5 minutes5 8 (1-10) 7 (0-10) <0.001
Side hernia6, n (%)
Left 128 (81.5) 46 (79.3)
0.83
Right 25 (15.9) 10 (17.2)
Bilateral 3 (1.9) 2 (3.4)
Liver up7 47 (30.9) 23 (50) 0.02
Major cardiac malformations , n (%) 8
1 (0.6) 8 (14) 0.001
Other birth defects9, n (%) 19 (12.2) 9 (15.8) 0.49
Chromosomal anomalies , n (%) 10
6 (3.8) 7 (12.5) 0.04
Pulmonary hypertension , n (%) 11
52 (38) 45 (93.8) <0.001

Treatment/ surgical complications

Use of inhaled NO12 (a), n (%) 43 (28.5) 45 (78.9) <0.001
ECMOb, n (%) 28 (17.9) 38 (65.5) <0.001
Duration of ECMO, mean (SD) 7.8 (3.3) 9.4 (3.7) 0.11
Repaired patients, n (%) 157 (100) 40 (69) <0.001
Method of repair, n (%)
Primary 113 (72) 6 (15) <0.001
Patch 44 (28) 34 (85)
DOL at surgical repair, median (range) 6 (2-25) 6 (1-16) 0.03
Closure of fascia13, n (%) 119 (82.1) 22 (56.4) 0.001
Abdominal patch14, n (%) 12 (7.8) 16 (41) <0.001
Surgical complications of repaired patients (n=197), n (%) 37 (23.6) 23 (57.5) <0.001
Surgical hemorrhage, n (%) 8 (5.1) 12 (30) <0.001
Chylothorax, n (%) 22 (14) 11 (27.5) 0.04
Missing values: 112, 233, 337, 445, 544, 61, 717, 82, 92, 103, 1130, 127, 1331, 145
a
NO: Nitric Oxide; bECMO: Extracorporeal Membranous Oxygenation

repaired patients, 95% survived the one year study period,
compared to 56% of the patch repaired patients (p< 0.001).
Survival was significantly lower in the group that needed ECMO
(42%) compared to those that were not treated with ECMO (87%)
(p< 0.001). When this latter group was corrected for the fourteen
patients who had a contra-indication for ECMO, survival was
96%. Surgical morbidity such as inability to close the fascia, use
of an abdominal patch, surgical site hemorrhage, and chylothorax
were all encountered significantly more often in non-survivors.
Surgical complications compared between survivors and non-
survivors are also presented in (Figure 1). Moreover, those who
did not survive required more surgeries than survivors (median
3 and 1, respectively), which included removal of abdominal
patches, ECMO canulation and decanulation, though this was not
statistically significant (p=0.10). A sub analysis for major cardiac
malformations (n=9) showed that these patients had a very
high frequency of mortality (89%) and pulmonary hypertension
(84%). Moreover, they were less often repaired (44.4%) versus
those without cardiac malformations (versus 94.1%, p< 0001).
Discussion
In this retrospective cohort study we examined several factors
that could be associated with surgical outcome in CDH patients.
The overall 1-year mortality rate in this study was 27%. Diverse
overall survival rates have been reported, ranging from 40% to
90%, [6,7,14]. However, as in ours and most other studies the so
called hidden mortality of CDH, including antenatal losses and
terminated pregnancies, are not taken into account [4,15,16]. The
survival rates for the different defect sizes were also comparable
to other studies, ranging from 99% in a defects and 39% in D
defects in the study of Harting et al., (2014) to 100% respectively
46% in this study [14]. Mortality is highest for CDH patients
in need of ECMO treatment, which was 58% in our study. Also
inborn patients had a higher mortality (Table 4), which could be

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100
90

Incidence (%)
80
70
60
50
40
30
20
10 Survivors
0
Non-survivors

Figure 1 Surgical complications after repair in CDH patients.

This figure shows the comparison of surgical complications between survivors and non survivors. Surgical complications, surgical hemorrhage and chylothorax were
statistically significant (p< 0.001, p< 0.001 and p=0.04 respectively).

based on the fact that larger defects, with smaller lungs are more
easily detected prenatally and therefore a planned birth in a high
volume center. Unfortunately, the observed/expected lung-to-
head ratio, an early predictor of high risk CDH patients, was not
well documented in our cohort and therefore not included in the
analysis.
The surgical complication rate was 31% of the repaired
patients, of which 14% hemorrhage postoperative, 17%
chylothorax and recurrence occurred in 6% within one year. No
diaphragm patch infections were encountered within the year.
Due to the retrospective nature of this study, some data was
unfortunately incomplete. For the primary outcome parameters
and survival however, no major differences were expected in the
results. Moreover, if the data had missing results in these main
outcome parameters they were excluded from the comparison on
survival. The secondary outcomes with too many missing values
were included in the comparison, but no conclusion could be
made on these results (Table 4). Patients who did not survive had
lower Apgar scores, had more major cardiac and chromosomal
anomalies, more often needed ECMO treatment and had more
patch repairs, which is also known from previous studies [2,17-
19]. However, specific surgical outcomes have not been related to
survival or disease severity previously. Our results show that non-
survivors had more surgical complications, such as hemorrhage
and chylothorax, which suggests a relation of these complications
with the severity of the disease. It is often stated that the size of the
defect is a surrogate for the severity and therefore that the need
for a patch indicates a more severely affected patient. However,
the rate of recurring diaphragmatic hernia within one year in this
cohort was 6%, without a significant difference between primary
and patch repaired patients. This might suggest that there is no
relationship between surgical morbidity and the severity of the
disease or defect size. Though a longer follow up might show a
significant difference in favor of primary respectively patch, other
studies showed that most recurrences occur in the first year life
[20]. The low recurrence rate of the current study is probably
based on the fact that they are treated in a high volume center and
all CDH’s are repaired in a standardized manner. Preoperative
care and timing of surgery is also standardized and in all patients
repaired with a patch, a polytetrafluorethylene (PTFE), Gore-
Tex® patch was used. Although various recurrence rates of
PTFE patches have been described, without a clear superiority
in the patch material [19-25], in this cohort there is no bias in
patch material, because the sole use of Gore-Tex® patches. Slight
downside of Gore-Tex® patches is the restriction in stretching
during growth of the patient and diaphragm [21-23]. Comparison
of recurrence rates of CDH repair with patches is difficult because
in most studies the inclusion of the patients is from 9-46 years
ago; this explains the variability of the recurrence rates reported
in most studies (ranging from 4.5-41%) [21,23,24]. Because the
correlation between CDH characteristics and surgical outcomes
is complex, a multivariate logistic regression will be performed
on this cohort in the future. The independent odds ratios for the
risk on surgical outcomes for high risk patients requiring ECMO
and patch repair will be calculated by adjustment for each other.
CONCLUSION
This study gives an overview of the short term surgical
morbidity and mortality of CDH patients over the past 15
years in a high volume center. The mortality rate was 27% and
non survivors had a significant higher incidence of surgical
complications. Whether this increased surgical morbidity is
caused by the severity of the disease or that there is room for
improvement in the surgical treatment to decrease mortality and
morbidity remains to be seen. Using only PTFE patches could
account for the relatively low recurring diaphragmatic hernia
after one year.
REFERENCES
1. Leeuwen L, Fitzgerald DA. Congenital diaphragmatic hernia. Journal of
paediatrics and child health. 2014; 50: 667-673.
2. Morini F, Lally PA, Lally KP, Bagolan P. The Congenital Diaphragmatic
Hernia Study Group Registry. European journal of pediatric surgery.
2015; 25: 488-496.
3. Greer JJ. Current concepts on the pathogenesis and etiology of
congenital diaphragmatic hernia. Respir Physiol Neurobiol. 2013;
189: 232-240.

Ann Emerg Surg 2(1): 1005 (2017)

5/6


Central 
Bringing Excellence in Open Access
4. Wilkinson DJ, Losty PD. Management of congenital diaphragmatic
hernia. Paediatrics and Child Health. 2013; 24: 23-26.
5. Danzer E, Hedrick HL. Controversies in the management of severe
congenital diaphragmatic hernia. Semin in fetal neonatal med. 2014;
19: 376-384.
6. Losty PD. Congenital diaphragmatic hernia: where and what is the
evidence? Semin pediatr surg. 2014; 23: 278-282.
7. Badillo A, Gingalewski C. Congenital diaphragmatic hernia: treatment
and outcomes. Semin Perinatol. 2014; 38: 92-96.
8. Mugford M, Elbourne D, Field D. Extracorporeal membrane
oxygenation for severe respiratory failure in newborn infants.
Cochrane Database Syst Rev. 2008; 16: 3.
9. Keijzer R, Wilschut DE, Houmes RJ, van de Ven KP, van den Hout L,
Sluijter I, et al. Congenital diaphragmatic hernia: to repair on or off
extracorporeal membrane oxygenation? J Pediatr Surg. 2012; 47: 631-
636.
10. Puligandla PS, Grabowski J, Austin M, Hedrick H, Renaud E, Arnold M,
et al. Management of congenital diaphragmatic hernia: A systematic
review from the APSA outcomes and evidence based practice
committee. J Pediatr Surg. 2015; 50: 1958-1970.
11. Lally KP, Lasky RE, Lally PA, Bagolan P, Davis CF, Frenckner BP, et
al. Standardized reporting for congenital diaphragmatic hernia--an
international consensus. J Pediatr Surg. 2013; 48: 2408-2415.
12. Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst
A, et al. Standardized postnatal management of infants with congenital
diaphragmatic hernia in Europe: the CDH EURO Consortium
consensus. Neonatology. 2010; 98: 354-364.
13. Van den Hout L, Tibboel D, Vijfhuize S, te Beest H, Hop W, Reiss I. The
VICI-trial: high frequency oscillation versus conventional mechanical
ventilation in newborns with congenital diaphragmatic hernia: an
international multicentre randomized controlled trial. BMC pediatr.
2011; 11: 98.
Cite this article
Heiwegen K, de Blaauw I, Janssen S, van Rooij IALM, van Heijst A, et al. (2017) Short Term Surgical Outcomes in the Treatment of Congenital Diaphragmatic
Hernia: An Overview of 15 Years Experience. Ann Emerg Surg 2(1): 1005.
Ann Emerg Surg 2(1): 1005 (2017)
Heiwegen et al. (2017)
Email:
14. Harting MT, Lally KP. The Congenital Diaphragmatic Hernia Study
Group registry update. Semin Fetal Neonatal Med. 2014; 19: 370-375.
15. Brownlee EM, Howatson AG, Davis CF, Sabharwal AJ. The hidden
mortality of congenital diaphragmatic hernia: a 20-year review. J
Pediatr Surg. 2009; 44: 317-320.
16. Harrison MR, Bjordal RI, Langmark F, Knutrud O. Congenital
diaphragmatic hernia: the hidden mortality. J Pediatr Surg. 1978; 13:
227-230.
17. Lupo E, Castoldi F, Maestri L, Rustico M, Dani C, Lista G. Outcome
of congenital diaphragmatic hernia: analysis of implicated factors.
Minerva pediatr. 2013; 65: 279-285.
18. Van den Hout L, Reiss I, Felix JF, Hop WC, Lally PA, Lally KP, et al.
Risk factors for chronic lung disease and mortality in newborns with
congenital diaphragmatic hernia. Neonatology. 2010; 98: 370-380.
19. Yao CT, Wang JN, Lin CH, Yeh CN, Tai YT, Wu MH, et al. Prediction of
outcome in infants with congenital diaphragmatic hernia or severe
diaphragmatic eventration. Acta Paediatr Taiwan. 2004; 45: 131-135.
20. Grethel EJ, Cortes RA, Wagner AJ, Clifton MS, Lee H, Farmer DL, et
al. Prosthetic patches for congenital diaphragmatic hernia repair:
Surgisis vs Gore-Tex. J Pediatr Surg. 2006; 41: 29-33.
21. Tsai J, Sulkowski J, Adzick NS, Hedrick HL, Flake AW. Patch repair for
congenital diaphragmatic hernia: is it really a problem? J Pediatr Surg.
2012; 47: 637-641.
22. Riehle KJ, Magnuson DK, Waldhausen JH. Low recurrence rate after
Gore-Tex/Marlex composite patch repair for posterolateral congenital
diaphragmatic hernia. J Pediatr Surg. 2007; 42: 1841-1844.
23. Moss RL, Chen CM, Harrison MR. Prosthetic patch durability in
congenital diaphragmatic hernia: a long-term follow-up study. J
Pediatr Surg. 2001; 36: 152-154.
24. Nasr A, Struijs MC, Ein SH, Langer JC, Chiu PP. Outcomes after muscle
flap vs prosthetic patch repair for large congenital diaphragmatic
hernias. J Pediatr Surg. 2010; 45: 151-154.
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