Effect of hernia sac on outcomes in infants with congenital diaphragmatic hernia

Abstract

Objective To explore the relationships between hernia sac and the outcomes in infants with congenital diaphragmatic hernia (CDH). Methods The medical records were retrospectively reviewed for 160 CDH neonates from January 2001 to December 2017.The presence or absence of hernia sac was identified intraoperatively.The clinical data included gestational age at diagnosis and delivery, gender, Apgar score at 1/5 min, birth weight, site of liver, admission arterial blood gas analysis, associated anomalies, operative approach, presence of hernia sac, size of defect, necessity of patch repairing and outcomes.They were divided into two groups of hernia sac and no-sac.Clinical parameters were compared and analyzed with SPSS 17.0 software. Results Among 160 CDH neonates, 83 infants underwent open surgery and another 77 mini-invasive surgery.Sixty-three patients had a hernia sac and another 97 without a hernia sac.Twenty-five (15.6%) patients underwent patch repairing.And 138 infants (86.3%) survived.Compared with those without hernia sac, patients with hernia sac had more favorable outcomes as quantified by significantly higher birth weight [(3 310.0±397.3) vs.(3 099.8±531.2)g], higher Apgar score at 1 & 5 min [(9.04±0.95)vs.(8.61±1.23), (9.63±0.60) vs.(9.19±0.98)], higher O/E LHR, higher pH (7.30±0.13 vs.7.22±0.14), lower PaCO2 (46.63±13.69 vs.60.53±21.00) and lower intraoperative requirement of patch repairing (6.3% vs.21.6%) (all P<0.05). However, no differences existed in gender, size of defect, operative approach or prenatal diagnosis.Compared with those in no-sac group, patients in sac group had a shorter duration of mechanical ventilation [(4.3±0.7) vs.(7.6±1.0) days], a shorter length of hospital stay [(21.7±11.5) vs.(28.1±15.8) days] and a higher survival rate [(96.8% vs.79.4%), all P<0.05]. Conclusions The presence of hernia sac indicates more favorable outcomes for CDH infants. Key words: Congenital diaphragmatic hernia; Hernia sac; Prognosis