title: Late surgical outcomes among congenital diaphragmatic hernia (CDH) patients: why long-term follow-up with surgeons is recommended.
abstract: BACKGROUND
  CDH patients experience multi-system morbidity. Despite apparent health, late childhood complications do occur. We reviewed the long-term surgical morbidity of our CDH patients to determine whether protracted clinical surveillance is warranted.
  
  
  METHODS
  A single-institution retrospective chart review of all CDH survivors treated from 1999 to 2011 who are followed at our CDH multidisciplinary clinic was performed. Descriptive and statistical analyses were performed to show risk of surgical complications over time.
  
  
  RESULTS
  A total of 187 CDH patients were treated with 160 surviving to discharge (86%). Primary repair was performed in 115 (73%), and 42 (27%) underwent patch repair. CDH recurrence occurred in 23 (15%) at a median time of 0.7 (range 0-8.5) years (65% asymptomatic). Seventy percent of recurrences occurred before 2 years and 17% after 4 years. Bowel obstruction occurred in 12 (8%) at a median time of 0.7 (range 0.2-7.2) years post-repair, and chest deformity occurred in 13 (8%) at a median of 5 (range 1.1-6.8) years. For patch repairs, scoliosis occurred in 4 (10%) patients at a median age of 3 (range 0.6-5) years.
  
  
  CONCLUSIONS
  Surgical complications in CDH survivors are common, can occur many years later, and are frequently asymptomatic. Long-term surveillance of CDH patients is recommended for early identification and treatment of complications.
authors.affiliation: Division of Pediatric Surgery, The Hospital for Sick Children, Toronto, ON, Canada M5G 1X8.
authors.forename: Tim
authors.initials: T
authors.lastname: Jancelewicz
authors.forename: Monping
authors.initials: M
authors.lastname: Chiang
authors.forename: Carol
authors.initials: C
authors.lastname: Oliveira
authors.forename: Priscilla P
authors.initials: PP
authors.lastname: Chiu
mesh_terms: D000359:Aftercare; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology; D013524:Surgical Flaps; D035441:Thoracic Wall / Q000002:abnormalities; D013997:Time Factors; D016896:Treatment Outcome