This is a survey on congenital posterolateral diaphragmatic hernia, conducted by Korean Association of Pediatric Surgeons (KAPS). A registration form for each patient during the 5-year period between 2010 and 2014 and a questionnaire were sent to each member. Twenty-six members in 16 institutions returned completed forms. Total patients were 219. Prenatal diagnoses were done in 181 cases (82.6%). Preoperative mortality was 11.4%. Minimal invasive surgery was done in 61 cases (31.8%). Risk factors related with death were Apgar score, oxygenation index, preoperative pH and bicarbonate, O2 saturation, the presence of hernia sac, and the size of defect. The neonatal survival and 1-year survival of total patients were 77.6% and 75.3%.
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There are considerable controversies in the management of congenital diaphragmatic hernia. By 1997, early operation, routine chest tube on the ipsilateral side and maintainingrespiratory alkalosis by hyperventilation were our principles (period I). With a transition period from 1998 to 1999, delayed operation with sufficient resuscitation, without routine chest tube, and permissive hypercapnia were adopted as our practice. High frequency oscillatory ventilation (HFOV) and nitric oxide (NO) were applied, if necessary, since year 2000(period II). Sixty-seven cases of neonatal Bochdalek hernia from 1989 to 2005 were reviewed retrospectively. There were 33 and 34 cases in period I and II, respectively. The neonatal survival rates were 60.6 % and 73.5 %, respectively, but the difference was not significant. In period I, prematurity, low birth weight, prenatal diagnosis, inborn, and associated anomalies were considered as the significant poor prognostic factors, all of which were converted to nonsignificant in period II. In summary, improved survival was not observed in later period. The factors considered to be significant for poor prognosis were converted to be nonsignificant after change of the management principle. Therefore, we recommend delayed operation after sufficient period of stabilization and the avoidance of the routine insertion of chest tube. The validity of NO and HFOV needs further investigation.
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