Congenital diaphragmatic hernia has a better prognosis when associated with a hernia sac.

Abstract

To evaluate neonatal mortality and morbidity up to 6months in neonates with congenital diaphragmatic hernia (CDH) with or without a hernia sac. Seventy-two cases of isolated CDH were included in a retrospective single-center study between January 2010 and December 2016. Hernia sac was defined at the time of surgery or at postmortem examination if the neonate died before surgery. Seventeen newborns (23.6%) had a hernia sac. Survival at 6months was significantly greater for isolated CDH with a hernia sac: 100% versus 63.6% (P=.003). High-frequency oscillatory ventilation was used significantly more in the no hernia sac group (P=.04). At surgery, the need for patch repair was significantly lower in the hernia sac group: 12% versus 50% (P=.005). The prenatal observed/expected lung-to-head ratio was significantly higher in the hernia sac group than in the no hernia sac group: 49.7% versus 38.6% (P<.05). The presence of a hernia sac in CDH is associated with better outcome, especially survival at 6months. If the presence of a hernia sac is recognized as a particular entity, which carries a good prognosis, it is necessary to be able to diagnose it prenatally, especially in the era of prenatal fetal surgery.