The results of treatment of newborns with right-sided and left-sided intrathoracic localization of the liver with diaphragmatic hernia

Abstract

BACKGROUND: The right-sided congenital diaphragmatic hernia is the rare pathology. Results of diagnostics, prognosis and treatment usally published as a collection of cases.

AIM: Comparition of treatment results of congenital diaphragmatic hernia with the liver as its content in dependancy of the side.

MATERIALS AND METHODS: We present a retrospective analysis of 50 newborn patients with congenital diaphragmatic hernia. Patiens were divided in two groups, first — with right-sided (19 patients), and second — with left-sided hernia (31 patients). Groups were compared by gender and weigth. Comparition criteria was the results of prenatal and postnatal diagnostics, intraoperative data, postoperative period, complications and outcomes.

RESULTS: We found predominance of prenatal diagnosis in the second group (48% vs 84%, p = 0,001). The lung-to-head circumference ratio were the same in both groups (0,52 in first, 0,46 in second, p = 0,058). Chance to use thoracoscopic approach in the second group was higer in 5,7 times (48% vs 84%). Postoperative period was easier in the group of right-sided congenital diaphragmatic hernia: artificial ventilation lasted on average 8 days (min 3; max 28) versus 11 (min 4; max 50) days in the first group (p = 0,036).

Hospital stay was significantly lower in the second group — 18 days (min 12; max 28), versus 50 days in the first group (min 13; max 64), p = 0,011. Recovery chance in patients with right-sided hernia was higher (45% vs 79%, confidence interval 0,059–0,814).

CONCLUSIONS: Every type of diaphragmatic hernia, including right-sided location, need to be the subgect of research of high compitantive center. Prognostic criteria for right-sided congenital diaphragmatic hernia require furter advanced study, wich is possible only in case of concentration of patients in the same center.

Keywords

congenital diaphragmatic hernia / antenatal diagnosis / malformations / newborns / thoracoscopy / ECMO

References

[1] Alghamdi A, Raboe E. Right Bochdalek congenital diaphragmatic hernia: a tertiary center’s experience over 13 years. Ann Pediatr Surg. 2021;17(1):24. DOI: 10.1186/s43159-021-00081-z

[2] Alghamdi A., Raboe E. Right Bochdalek congenital diaphragmatic hernia: a tertiary center’s experience over 13 years // Ann Pediatr Surg. 2021. Vol. 17, No. 1. P. 24. DOI: 10.1186/s43159-021-00081-z

[3] Aihole JS. Congenital right diaphragmatic defects: Our institutional experience. Afr J Paediatr Surg. 2021;18(3):133–138. DOI: 10.4103/ajps.AJPS_29_20

[4] Aihole J.S. Congenital right diaphragmatic defects: Our institutional experience // Afr J Paediatr Surg. 2021. Vol. 18, No. 3. P. 133–138. DOI: 10.4103/ajps.AJPS_29_20

[5] Ovsyannikov PA, Kosovtsova NV, Ryabokon NR, et al. Congenital diaphragmatic hernia. A systematic analysis. Journal of Obstetrics and Women’s Diseases. 2022;71(2):101–112. (In Russ.) DOI: 10.17816/JOWD88926

[6] Овсянников Ф.А., Косовцова Н.В., Рябоконь Н.Р., и др. Врожденная диафрагмальная грыжа: систематический анализ // Журнал акушерства и женских болезней. 2022. Т. 71, № 2. С. 101–112. DOI: 10.17816/JOWD88926

[7] Chukanov AN. Prenatal prediction of outcomes in congenital diaphragmatic hernia based on fetal 3D/4D ultrasound lung morphometry and histogram analysis (a pilot study). Ultrasound and Functional Diagnostics. 2022;(1):19–26 (In Russ.) DOI: 10.24835/1607-0771-2022-1-19-26

[8] Чуканов А.Н. Пренатальное прогнозирование исходов диафрагмальной грыжи на основе трехмерной ультразвуковой морфометрии и оценки гистограмм легких плода // Ультразвуковая и функциональная диагностика. 2022. № 1. С 19–26. DOI: 10.24835/1607-0771-2022-1-19-26

[9] Syrkashev EM, Solopova AE, Bychenko VG, et al. Predicting outcomes of congenital diaphragmatic hernia by calculating liver herniation derives. Neonatology: News, Opinions, Training. 2021;9(1):24–29. (In Russ.) DOI: 10.33029/2308-2402-2021-9-1-24-29

[10] Сыркашев Е.М., Солопова А.Е., Быченко В.Г., и др. Прогнозирование исходов врожденной диафрагмальной грыжи плода путем вычисления производных смещения печени // Неонатология: новости, мнения, обучение. 2021. Т. 9, № 1. С. 24–29. DOI: 10.33029/2308-2402-2021-9-1-24-29

[11] Rafat N, Schaible T. Extracorporeal membrane oxygenation in congenital diaphragmatic hernia. Front Pediatr. 2019;7:336. DOI: 10.3389/fped.2019.00336

[12] Rafat N., Schaible T. Extracorporeal Membrane oxygenation in congenital diaphragmatic hernia // Front Pediatr. 2019. Vol. 7. P. 336. DOI: 10.3389/fped.2019.00336

[13] Lapshin VI, Razin MP, Akselrov MA, et al. Toracoscopic treatment of the newborn infant with false right sided diaphragm hernia. Russian Journal of Pediatric Surgery. 2019;23(2):106–109. (In Russ.) DOI: 10.18821/1560-9510-2019-23-2-106-109

[14] Лапшин В.И., Разим М.П., Аксельров М.А., и др. Торакоскопическое лечение новорожденного с ложной правосторонней диафрагмальной грыжей // Детская хирургия. 2019. Т. 23, № 2. С. 106–109. DOI: 10.18821/1560-9510-2019-23-2-106-109

[15] Lovskaya II, Chepurnoy MG, Chepurnoy GI, et al. An actual methods of right-sided congenital diaphragmatic hernias surgical treatment. Medical Herald of The South of Russia. 2014;(3):117–120. (In Russ.)

[16] Ловская И.И., Чепурной М.Г., Чепурной Г.И., и др. Современные подходы к хирургическому лечению правосторонних врожденных диафрагмальных грыж // Медицинский вестник Юга. 2014. № 3. С. 117–120.

[17] Burgos CM, Frenckner B, Luco V, et al. Right versus left congenital diaphragmatic hernia — What’s the difference? J Pediatr Surg. 2017;53(1)113–117. DOI: 10.1016/j.jpedsurg.2017.10.027

[18] Burgos C.M., Frenckner B., Luco V., et al. Right versus left congenital diaphragmatic hernia — What’s the difference? // J Pediatr Surg. 2017. Vol. 53, No. 1. P. 113–117. DOI: 10.1016/j.jpedsurg.2017.10.027

[19] Russo FM, Cordier AG, Basurto D, et al. Fetal endoscopic tracheal occlusion reverses the natural history of right-sided congenital diaphragmatic hernia: European multicenter experience. Ultrasound Obstet Gynecol. 2021;57(3):378–385. DOI: 10.1002/uog.23115

[20] Russo F.M., Cordier A.G., Basurto D., et al. Fetal endoscopic tracheal occlusion reverses the natural history of right-sided congenital diaphragmatic hernia: European multicenter experience // Ultrasound Obstet Gynecol. 2021. Vol. 57, No. 3. P. 378–385. DOI: 10.1002/uog.23115

[21] Schaible T, Kohl T, Reinshagen K, et al. Right- versus left-sided congenital diaphragmatic hernia: postnatal outcome at a specialized tertiary care center. Pediatr Crit Care Med. 2012;13(1):66–71. DOI: 10.1097/PCC.0b013e3182192aa9

[22] Schaible T., Kohl T., Reinshagen K., et al. Right- versus left-sided congenital diaphragmatic hernia: postnatal outcome at a specialized tertiary care center // Pediatr Crit Care Med. 2012. Vol. 13, No. 1. P. 66–71. DOI: 10.1097/PCC.0b013e3182192aa9

[23] Jeong J, Lee BS, Cha T, et al. Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience. BMC Pediatr. 2021;21(1):460. DOI: 10.1186/s12887-021-02931-6

[24] Jeong J., Lee B.S., Cha T., et al. Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience // BMC Pediatr. 2021. Vol. 21, No. 1. P. 460. DOI: 10.1186/s12887-021-02931-6

[25] Abramov A, Fan W, Hernan R, et al. Comparative outcomes of right versus left congenital diaphragmatic hernia: A multicenter analysis. J Pediatr Surg. 2020;55(1):33–38. DOI: 10.1016/j.jpedsurg.2019.09.046

[26] Abramov A., Fan W., Hernan R., et al. Comparative outcomes of right versus left congenital diaphragmatic hernia: A multicenter analysis // J Pediatr Surg. 2020. Vol. 55, No. 1. P. 33–38. DOI: 10.1016/j.jpedsurg.2019.09.046

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