Anand Prabhavathy Raghavan1, Gejoe George2
CNS anomalies coexist in up to 10% of non-syndrome CDH cases. Hence, the diagnosis, treatment and prognosis of CHD is of interest to paediatric neurosurgeons. Congenital diaphragmatic hernia (hereby referred to as CDH) is a relatively rare anomaly with a prevalence of 1 in 3000 livebirths. CDH present with varying characteristics (side, contents, presence of sac, morgagnian hernia), which in turn influence its outcome. Study details the characteristics of CDH, their impact on outcome, as well as short-term complications of CDH in general.
MATERIALS AND METHODS
Retrospective study- Descriptive, based on case records. Study subjects were all inpatients admitted with CDH during the study period in Paediatric Surgery Department, SAT Hospital, Trivandrum. No definite sampling method has been adopted for the study. Consecutive cases of CDH have been recruited. Statistical analysis is done by Chi-square test, proportion and percentage analysis. Data were analysed using computer software, Statistical Package for Social Sciences (SPSS) version 10.
Cases which contained stomach as a content (18/56 or 32.14%) had a poor survival (8/18 or 44.44%) and this result was found to be statistically significant (P value 0.033). Sac was seen in 15 (26.7%) cases and the survival was poor in these cases (7/15 or 46.7%, P value 0.096). None of the cases had any CNS anomalies. Outcome was bad for right-sided hernias. Short-term complications other than postoperative death were few.
Presence of sac as well as stomach as a content of sac in CDH leads to poor survival. None of the cases had coexisting CNS anomalies, which may not be statistically significant. It may be due to the greater number of stillbirths in foetuses associated with CNS anomalies (which were not included) in our study group during the given study period. Mortality of right-sided hernias exceeded that of left-sided defects, which is against the commonly held belief (our study is supported by Touloukian-Gibson report and Skari, et al study). Surgical complications are few and mainly due to respiratory infection and adhesive obstruction. Surgically-treated patients do well if they survive the operation.