EN
TÜRKÇE
Poster - 135
Changing trends in surgical management and outcomes of congenital diaphragmatic hernia: a 17 year era-based institutional review
Mansoor Ahmed, Wael Fadel, Brian Sweeney, Farhan Tareen
Children's Health Ireland, Dublin, Ireland
Background:
Congenital diaphragmatic hernia (CDH) remains one of the most challenging neonatal surgical conditions, requiring multidisciplinary perioperative management. Surgical approaches and perioperative care have evolved considerably over recent decades.
Methods:
A retrospective cohort study was performed including all neonates operated for CDH between January 2009 and December 2025 at a tertiary pediatric surgical centre. Patients were divided into three treatment eras (2009–2012, 2013–2019, and 2020–2025). Demographic variables, physiological parameters, operative findings, surgical approach, recurrence, and survival outcomes were analysed. Continuous variables were analysed using Mann–Whitney U and Kruskal–Wallis tests, while categorical variables were compared using Chi-square testing. Statistical significance was defined as p < 0.05.
Results:
A total of 249 patients were included. Overall survival was 87.7%. Median gestational age was 38 weeks (IQR 37–39), and median birth weight was 3.1 kg (IQR 2.7–3.48). Open repair remained the predominant operative approach (89.4%), while thoracoscopic repair accounted for 6.0% of procedures.
Survivors demonstrated significantly higher birth weight (p=0.002), higher 5-minute Apgar scores (p<0.001), higher initial arterial pH (p<0.001), and lower initial pCO₂ levels (p=0.042). Patch repair and liver-up anatomy were associated with increased recurrence risk. Survival improved across treatment eras, although this did not reach statistical significance (p=0.469).
Conclusion:
Substantial evolution in perioperative stabilization and surgical management of CDH has occurred over the past 17 years. Improved neonatal intensive care and multidisciplinary surgical management have contributed to survival outcomes comparable with major international centres.