Experience with the Management of Congenital Diaphragmatic Hernia at the University College Hospital, Ibadan

Abstract

A retrospective review of 44 cases of congenital diaphragmatic hernia (CDH) treated at the Cardiothoracic Surgical Unit, University College Hospital (UCH), Ibadan, between August 1976 and May 1999, was carried out. Thirty (68.2 per cent) of the 44 were males and 14 (13.8 per cent) were females. The patients were analysed in three groups: 31 patients who underwent surgery were analysed as two groups: inborn (born within UCH), 10 patients, and outborn (born elsewhere), 21 patients; the third group consisted of 13 patients who were not operated upon. All the inborn patients and 18 (85.7 per cent) of the outborn had left-sided defects; the remaining three of the outborn had right-sided defects. Eleven (84.6 per cent) of those who didn't undergo surgery, had left-sided defects while the remaining 15.4 per cent had bilateral defects. The three groups had comparable gestational ages (inborn vs outborn, p> 0.05; inborn vs unoperated, p> 0.05; outborn vs unoperated, p>0.05) and birth weights ( inborn vs outborn, p>0.05; inborn vs unoperated, p>0.05; outborn vs unoperated, p> 0.05). Those who did not undergo surgery had lower Apgar scores and higher incidence of associated congenital malformations than the patients who underwent surgical repairs. The differences in the mean of 5 minute Apgar scores among the three groups were not statistically significant (p> 0.05). Age at surgery was higher in the outborn (mean 55.5 ± 42.2 hours) than the inborn (mean 9.2 ± 3.9 hours) patients. The difference between the mean age at surgery was statistically significant (p< 0.05). Majority of those requiring operation (24 patients, 77.4 per cent) had repair by thoracotomy, while the remaining seven (22.6 per cent) had repair by the abdominal approach. Most of the patients had primary repair while two required diaphragmatic patches with dacron. Sixty per cent of the inborn patients required post-operative ventilation compared with only 23.8 per cent of the outborn. Survival was 71.4 per cent for the outborn and 40 per cent for the inborn. It is concluded that CDH is a disease with a range of severity. The higher survival rate among the more mature outborns suggest a natural selection of those with minimum respiratory impairment.

Keywords: Congenital, Diaphragmatic hernia.

Nigerian Journal of Paediatrics 2002;29:40-46.