WOFAPS 2025 8th World Congress of Pediatric Surgery

Ryan Mario Christian, Muhammad Rafi Wibisana Sudradjat

Faculty of Medicine Padjadjaran University, Bandung, Indonesia

Background: Congenital diaphragmatic hernia (CDH) is a serious congenital defect causing herniation of abdominal contents into the chest, resulting in pulmonary hypoplasia and long-term respiratory issues. Most cases are left-sided (L-CDH), but right-sided defects (R-CDH) have unique challenges. The effect of laterality on long-term lung function is unclear.

Method: Following Cochrane Rapid Review guidelines, this review analyzed studies reporting long-term lung function (≥1 year) in pediatric CDH survivors, comparing left- and right-sided defects. Databases searched included PubMed, Scopus, and Web of Science through July 2025, focusing on spirometry, oxygen needs, chronic lung disease, and lung structure.

Results: Both L-CDH and R-CDH survivors show persistent mild-to-moderate airway obstruction and reduced diffusion capacity into adolescence, irrespective of ECMO or initial severity. R-CDH is linked to greater supplemental oxygen need at discharge, increased respiratory support including tracheostomy, and more severe pulmonary hypoplasia, despite similar mortality and pulmonary hypertension rates as L-CDH. L-CDH is more often prenatally diagnosed and associated with higher risk of severe pulmonary hypertension and neonatal mortality. Long-term lung function in survivors is similar between groups, though L-CDH may require less chronic respiratory support. Both have significant ipsilateral lung volume loss and impaired alveolar development; the left lung is more affected in L-CDH. About 20–50% of survivors experience chronic pulmonary morbidity.

Conclusion: CDH laterality affects long-term lung outcomes, with R-CDH linked to greater respiratory support needs and L-CDH linked to higher early mortality. Both require ongoing multidisciplinary follow-up.