Analysis of risk factors of long-term complications in congenital diaphragmatic hernia: A single institution's experience.
OBJECTIVE
To establish better management practices to reduce morbidities in survivors with congenital diaphragmatic hernia (CDH).


METHODS
Of 60 patients treated for CDH at our institution between 1991 and 2011, 49 patients without severe anomalies were retrospectively reviewed.


RESULTS
Since 2004, gentle ventilation (GV) has been the main treatment for CDH. Patients were divided into the following two groups: the non-GV group (n = 29) who were treated before GV treatment was implemented, and the GV group (n = 20). The overall survival rate was 62.1% (18/29) and 95% (19/20) in the non-GV and GV groups, respectively (p = 0.016). Despite the high survival rate, the incidence of long-term complications in survivors was still high (14/19, 73.7%) in the GV group. In the GV group, liver-up (p = 0.106) and the need for patch repair (p = 0.257) tended to be associated with the development of long-term complications, but did not reach statistical significance. The presence of perioperative complications was associated with the development of long-term complications (p = 0.045) in the GV group.


CONCLUSIONS
Patients who developed short-term complications seemed to be at risk of long-term complications. Therefore, to minimize long-term morbidities in CDH survivors, the prevention of short-term complications might be important.
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. Electronic address: hajime0723@gmail.com.
Hajime
H
Takayasu
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Kouji
K
Masumoto
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Takahiro
T
Jimbo
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Naoya
N
Sakamoto
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Takato
T
Sasaki
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Toru
T
Uesugi
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Chikashi
C
Gotoh
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Yasuhisa
Y
Urita
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Toko
T
Shinkai
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications* / Q000401:mortality / Q000628:therapy; D059685:Herniorrhaphy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
congenital diaphragmatic hernia; gentle ventilation; long-term complications; morbidities; short-term complications