Right versus left congenital diaphragmatic hernia – What's the difference?

Abstract

BackgroundRight-sided congenital diaphragmatic hernias (CDH) and bigger defect sizes have been associated with poorer outcomes. AimThe aim of this study was to evaluate right- and left-sided CDH in terms of size, survival, associated anomalies, and morbidity. Material and methodsWe used information from a multicenter, multinational database including patients with CDH born between 2007 and 2015. All infants with data on defect side were included for this analysis. We compared differences in outcomes between right- and left-sided CDH. Further analysis on the association between side, size of the defect, and outcome was performed. ResultsA total of 3754 cases of CDH were entered in the registry between January 2007 and September 2015, with an overall survival of 71%. Of those, 598 (16%) were right-sided and 3156 left-sided, with a survival rate of 67% and 72%, respectively. Right-sided CDH had a larger proportion of C and D defects (p<0.001 and 0.04, respectively). Survival rates for the same size defect were similar, independent of the side of the defect. Multivariable logistic regression analysis with survival as dependent variable identified a significant correlation with defect size, but not side. ConclusionsThe higher proportion of large defects (C & D) in right-sided CDH, not the side itself, accounts for the reported poorer survival in right-sided CDH. Level of evidenceLevel I for a prognosis study – This is a high-quality, prospective cohort study with 99% of patients followed to the study end point (death or discharge).