A systematic review and meta-analysis of surgical morbidity of primary versus patch repaired congenital diaphragmatic hernia patients

AbstractLarge studies comparing the surgical outcome of primary versus patch repair in congenital diaphragmatic hernia (CDH) patients are rare. This study aims to evaluate the incidence of surgical complications in both types of CDH repair. PubMed, EMBASE, Cochrane and Web of Science were searched for peer-reviewed articles. Studies on CDH between 1991 and August 2020 were systematically screened and meta-analyses were performed. Primary outcomes of this review were: haemorrhage, chylothorax, recurrences and small bowel obstruction (SBO). A total of 6436 abstracts were screened, after which 25 publications were included (2910 patients). Patch repaired patients have a 2.8 times higher risk on developing a recurrence (20 studies) and a 2.5 times higher risk on developing a chylothorax (five studies). Moreover, they have a two times higher risk on developing a SBO. No studies could be included that evaluated the incidence of surgical haemorrhage between these patients. Although the quality of the studies was relatively low, patch repaired patients have a higher risk on developing a recurrence, chylothorax and small bowel obstruction. Large prospective studies are required to adjust for severity of disease, to reveal the true causative factors in order to minimize the risk on these surgical complications in both types of patients.

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Malrotation in Congenital Diaphragmatic Hernia: Is It Really a Problem?

European Journal of Pediatric Surgery ◽

10.1055/s-0039-1692165 ◽

2019 ◽

Vol 30 (05) ◽

pp. 434-439 ◽

Cited By ~ 1

Author(s):

Ivo de Blaauw ◽

Julia van Ling ◽

Sanne M. B. I. Botden ◽

Kim Heiwegen

Keyword(s):

Small Bowel ◽

Congenital Diaphragmatic Hernia ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Diaphragmatic Hernia ◽

High Volume ◽

Acute Surgery ◽

High Volume Center ◽

Acute Small Bowel Obstruction ◽

Intestinal Rotation

Abstract Introduction Congenital diaphragmatic hernia (CDH) has been associated with other congenital malformations, such as intestinal rotation abnormalities. However, there is no standard evaluation and treatment of intestinal rotation during initial CDH repair. This study evaluates intestinal malrotation in CDH patients. Materials and Methods All patients with a CDH treated in a high-volume center between 2000 and 2015 were retrospectively evaluated. Demographics, gastrointestinal characteristics, surgical treatment, and abdominal outcomes (acute surgery, small bowel obstruction, and volvulus) were described. Results A total of 197 CDH patients were surgically repaired. In 76 (39%) patients, a malrotation was described at initial CDH repair, in 39 (20%) patients, a normal rotation, but 82 patients (42%) had no report on intestinal rotation. During follow-up (range: 2–16 years), 12 additional malrotations were diagnosed, leading to a prevalence of at least 45% (n = 88). These were mostly diagnosed due to acute small bowel obstruction, of which three had a volvulus. Of the 12 later diagnosed malrotations, 58% required acute surgery, compared to 3% of the 76 initially diagnosed patients (p < 0.001). Conclusion Malrotation is associated with CDH, with a prevalence of at least 45% and in 21% a normal intestinal rotation. “Missed” malrotations have a higher risk on need for acute surgery later in life.

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META-ANALYSIS ON ETIOPATHOGENESIS OF SMALL BOWEL OBSTRUCTION IN THE DEPARTMENT OF GEN. SURGERY P.M.C.H. & K.M.C.H., BIHAR

10.36106/ijsr/6700138 ◽

2021 ◽

pp. 1-3

Author(s):

Abhishek Chaudhary ◽

Kanchan Sone Lal Baitha ◽

Yasir Tajdar

Keyword(s):

Small Intestine ◽

Small Bowel ◽

Abdominal Surgery ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Meta Analysis ◽

Ileocaecal Valve ◽

Time Period ◽

Ligament Of Treitz

Background:The small intestine is the longest and convoluted portion in the digestive tract. It starts from pylorus and ends at ileocaecal valve. The small bowel consists of three parts measuring about 5 to 6 meters. The rst 25cm is the duodenum. Out of the rest part of small gut, jejunum th th. constitute the proximal 2/5 and ileum distal 3/5 The jejunum and ileum extend from the peritoneal fold that supports the duodeno-jejunal junction (Ligament of Treitz) down to ileocaecal valve. Material and Methods:All the patients admitted to PMCH, Patna and KMC, Katihar as intestinal obstruction was included for the study. The time period of study was from October 2014 to November 2016 in PMCH and December 2016 to January 2019 in KMC, Katihar. Out of all Intestinal obstruction 59 cases only of adult small gut obstruction were recorded for comparison and conclusive study.Conclusion: Small bowel obstruction remains a frequently encountered problem in abdominal surgery. Although modern day surgical management continues to focus appropriately on avoiding delayed operation, whatever surgery is indicated, not every patient is always best served by immediate operation

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