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Choi, Lee, and Hong: Late Lung Function in the Repaired Congenital Diaphragmatic Hernia
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(2): 143-148.

Published online: 2 August 2010

DOI: https://doi.org/10.4174/jkss.2010.79.2.143

Late Lung Function in the Repaired Congenital Diaphragmatic Hernia

Su Yun Choi, M,D., Ho Won Lee, M.D.1, Jeong Hong, M,D.1

Department of Surgery, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea.

1Department of Surgery, Ajou University Medical Center, Suwon, Korea.

Corresponding author (hongj@ajou.ac.kr)

Received 30 September 2009       Accepted 24 May 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Congenital diaphragmatic hernia is an uncommon cause of respiratory distress in newborn infants and initially characterized by severe restrictive lung dysfunction. The problems of initial management and short-term prognosis have been well reported. However, long-term outcome has not been clearly defined. We studied the late respiratory problems and lung function after repair of congenital diaphragmatic hernia.

Methods

Fourteen patients who had repaired congenital diaphragmatic hernia at Ajou University from January 1995 to August 2009 were included for this study.

Results

Six cases (42.8%) showed late respiratory problems including recurrent bronchiolitis, pneumonia, bronchial asthma and prolonged chest wall retraction. Lung perfusion scan showed a perfusion defect in 1 case whose mean perfusion to the operated side was lower than the unaffected lung. Pulmonary function test showed restrictive pulmonary insufficiency in 2 cases. The cases with the late pulmonary problems revealed more restrictive pulmonary insufficiency compared to those without. The prolonged time taken to surgery from diagnosis, prolonged intensive care time, and prolonged ventilator care after surgery have been found to be the determinants of the impaired pulmonary functions.

Conclusion

In summary, a portion (about 20%) of the patients with congenital diaphragmatic hernia showed impaired pulmonary function, even when they had no apparent respiratory symptom or limitations of activities. From these results, regular long-term follow-up of lung function is required postoperatively in patients with congenital diaphragmatic hernia, especially in cases with the aforementioned risk factors.

Keywords: Congenital diaphragmatic hernia, Late pulmonary problem, Lung function after repair

Figures and Tables

Table 1
Symptoms and signs of congenital diaphragmatic hernia
jkss-79-143-i001
Table 2
Demographic data of the congenital diaphragmatic hernia
jkss-79-143-i002
Table 3
Surgical factors and development of late respiratory problems
jkss-79-143-i003

Data are mean±SD.

Table 4
Late respiratory problems after repair of the congenital diaphragmatic hernia
jkss-79-143-i004
Table 5
Lung perfusion scans in six congenital diaphragmatic hernias
jkss-79-143-i005

*Diffuse decreased perfusion.

Table 6
Pulmonary function test in eight congenital diaphragmatic hernias
jkss-79-143-i006

*FVC = forced vital capacity; †FEV = forced expiratory volume at one second; ‡FEF25~75% = forced expiratory flow between 25 and 75 percent of the volume; §SVC = static vital capacity. Data are medians (inter-quatile range).

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