title: Congenital diaphragmatic hernia.
abstract: There is a paucity of level 1 and level 2 evidence for best practice in surgical management of CDH. Antenatal imaging and prognostication is developing. Observed to expected lung-to-head ratio on ultrasound allows better predictive value over simple lung-to-head ratio. Based on 2 randomised studies, the verdict is still out in terms the best group and indication for antenatal intervention and their outcome. Tracheal occlusion is best suited for prospective randomised studies of benefit and outcome. Only one pilot randomised controlled study of thoracoscopic repair exists, suggesting increased acidosis; blood gases and CO2 levels should be closely monitored. Only poorly controlled retrospective studies suggest higher recurrence rates. Randomised studies on the outcome of thoracoscopic repair are needed. Careful selection, anaesthetic vigilance, monitoring and follow-up of these cases are required. There is no evidence to suggest the best patch material to decrease recurrences. Evidence suggests no benefit from routine fundoplication based on the one randomised study. Multi-disciplinary follow-up is required. This can be visits to different specialities, but may be best served by a multi-disciplinary one-stop clinic.
authors.affiliation: Royal Hospital for Sick Children Edinburgh, Sciennes Road, Edinburgh, EH1 1LF, UK. Electronic address: merrillmchoney@nhs.net.
authors.forename: Merrill
authors.initials: M
authors.lastname: McHoney
mesh_terms: D005764:Gastroesophageal Reflux / Q000453:epidemiology; D017408:Guidelines as Topic; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications; D011296:Prenatal Diagnosis
keywords: Antenatal management; Carbon dioxide; Congenital diaphragmatic hernia; Fundoplication; Oxygenation; Patch repair; Surgery; Thoracoscopy; Tracheal occlusion