These slides will take you through Congenital Diaphragmatic Hernia (CDH) from an International Pediatric Surgery Teaching Series in 2023, presented by Milind Chitnis. It covers the following key areas:
Types and Embryology of CDH: CDH primarily presents as a posterolateral defect (Bochdalek hernia) in 75% of cases, followed by an antero-medial defect (Morgagni hernia) in 23%, and hiatus hernia in 2%. The condition arises from developmental defects in the closure of the pleuroperitoneal folds and muscularization, leading to lung hypoplasia.
Clinical Presentation and Diagnosis: CDH can be detected antenatally through ultrasound and MRI, and postnatally presents with respiratory distress, scaphoid abdomen, and mediastinal shift. Diagnostic imaging typically reveals hypoplastic lungs, stomach, and bowel shadows in the chest.
Preoperative Management: Effective preoperative strategies include monitoring overall perfusion, pulmonary hypertension, and cardiac function, alongside ventilatory support through pressure-controlled ventilation and permissive hypercarbia. Stabilization with minimal stimulation, fluid optimization, and possible use of ECMO are critical.
Surgical Management: Surgical repair, ideally performed after stabilization, may involve laparotomy or thoracotomy, with careful reduction of herniated contents and consideration for the use of synthetic patches for large defects. Minimally invasive surgery is an option for experts, with pros like less pain and shorter hospital stays but cons like higher recurrence rates.
Long-term Morbidity and Outcomes: Long-term complications can include pulmonary, neurodevelopmental, gastrointestinal, musculoskeletal, and surgical issues. Risk stratification is important, considering defect size, associated anomalies, and the volume of cases managed by the center. Despite advancements, CDH remains associated with high morbidity and mortality.