Intraoperative surgical complications of open surgery for congenital diaphragmatic hernia: a multicenter, observational study in Japan
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In brief
In brief
This multicenter Japanese study analyzed intraoperative complications in 852 neonates undergoing open CDH repair, finding a 6% organ injury rate with spleen being most commonly affected. Two percent required transfusion, with non-direct diaphragmatic closure identified as a risk factor for splenic injury.
- 6% of open CDH repairs resulted in intraoperative organ injury, most commonly splenic injury (62% of injuries).
- 2% of open CDH surgeries required blood transfusion due to organ injury during repair.
- Non-direct closure of diaphragmatic defect doubled the risk of splenic injury (OR 2.2, 95% CI 1.1-4.9).
- Spleen, liver, lungs, and intestine were the most frequently injured organs during open CDH repair.
- Laparotomy and thoracotomy for CDH carry measurable but manageable intraoperative complication rates in experienced centers.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study aimed to clarify surgical complications associated with open surgery for congenital diaphragmatic hernia (CDH).
Methods
We performed an exploratory data analysis of the clinical characteristics of surgical complications of neonates with CDH who underwent laparotomy or thoracotomy between 2006 and 2021. Data of these patients were obtained from the database of the Japanese CDH Study Group.
Results
Among 1,111 neonates with left or right CDH, 852 underwent open surgery (laparotomy or thoracotomy). Of these 852 neonates, 51 had the following surgical complications: organ injury (n = 48; 6% of open surgeries); circulatory failure caused by changes in the organ location (n = 2); and skin burns (n = 1). Injured organs included the spleen (n = 30; 62% of organ injuries), liver (n = 7), lungs (n = 4), intestine (n = 4), adrenal gland (n = 2), and thoracic wall (n = 2). Fourteen of the patients who experienced organ injury required a blood transfusion (2% of open surgeries). The adjusted odds ratio of splenic injury for patients with non-direct closure of the diaphragm was 2.2 (95% confidence interval, 1.1–4.9).
Conclusion
Of the patients who underwent open surgery for CDH, 2% experienced organ injury that required a blood transfusion. Non-direct closure of the diaphragmatic defect was a risk factor for splenic injury.