Congenital diaphragmatic hernia: Prognostic value of hernia sac and size of defect

Introduction: Congenital diaphragmatic hernia (CDH) is a congenital malformation with challenging management. The aim of this study was to evaluate the effect of the presence of hernia sac and defect size on the prognosis of CDH in Tabriz children’s hospital.

Methods: In this prospective study, all the infants with the diagnosis of CDH that were admitted to the Tabriz children’s hospital since 2016-2019 were enrolled. The presence or absence of a hernia sac was evaluated, and the largest diameter on diaphragmatic defect was measured before the repair. Postoperative outcomes, including instability, duration of mechanical ventilation, mortality rate, or hospital discharge were obtained and analyzed.

Results: Over the study period, 30 patients with CDH met the inclusion criteria, consisting of 15 males and 15 females. Fifteen cases were diagnosed during the first 24 hours of life and 16 cases experienced hypoxia in the first hour after birth. Defect size was significantly smaller in survived patients (P=0.041). Postoperative death occurred in 9 (42.85%) patients without a hernia sac. Results showed that none of the cases with hernia sac expired (P=0.035).

Conclusion: In our study, the presence of the hernia sac was related to a lower postoperative mortality rate. Defect size in survived group was also smaller. It can be suggested that the presence of hernia sac and lower diameter of defect size act as good prognostic factors in the outcome of patients with CDH.