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Long term outcomes of early and late diagnosed congenital diaphragmatic hernia and pulmonary asymmetry

Ali Ekber Hakalmaz, Senol Emre, Rahsan Ozcan, Gonca Tekant, Sinan Celayir.

Abstract
Aim: It is to determine problems in long-term follow-up of patients operated in infancy and newborn period for congenital diaphragmatic hernia in our clinic before one year of age and to evaluate significance of perioperative findings on long-term results.
Material and Methods: Among patients, 16 patient above 8 years of age with outpatient control in the past year were investigated retrospectively. Patients were grouped regarding operation age as newborn and infancy period. Preoperative predictive data, early and late postoperative findings, diagnostic studies, disorders were evaluated.
Results: Male-to-female ratio was 3/1, right-to-left sided hernia was 1/15. Average age was 13.1(9-17). Average follow-up was 13years (8-17 years). Thirteen patients were diagnosed in newborn period, 3 in infancy. On follow-up, 85% of newborns and 33% of infants were found to have at least one disorder. Scoliosis presented in 6, asthma in 5, gastroesophageal reflux (GER) in 4, pectus excavatum in 4, undescended testis in 3, failure to thrive in 2 patients. All the musculoskeletal system deformities were diagnosed in only newborn period patients. Four cases (25%) were uneventful. Spirometry revealed obstructive dysfunction in 1, restrictive in 2 patients. CT showed increased aeration and pulmonary asymmetry.
Conclusions: Among evaluated patients, 75% showing disorders requiring treatment or observation indicates the need for follow-up until adolescence.

Key words: Diaphragmatic Hernia; Long Term; Lung Volumetry; Pulmonary Asymmetry; Modified Ventilatory Index.



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