Clinical Outcomes of All Patients With Congenital Diaphragmatic Hernia Treated in Okinawa Prefecture Over the Past Two Decades and Reevaluation of the Severity Classification of Prenatally Diagnosed Patients

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  • Kuda Masaaki
    Department of Digestive and General Surgery, University of the Ryukyus
  • Ikemura Shun
    Medical Student, University of the Ryukyus
  • Baba Tokuro
    Department of Digestive and General Surgery, University of the Ryukyus
  • Goya Hideki
    Maternity and Perinatal Care Center, University of the Ryukyus Hospital
  • Kinjo Tadatsugu
    Maternity and Perinatal Care Center, University of the Ryukyus Hospital
  • Sanabe Naoya
    Department of Pediatric Surgery, Naha City Hospital
  • Kinjo Tsukasa
    Department of Pediatric Surgery, Okinawa Nanbu Prefectural Medical Center and Children’s Medical Center
  • Yoshida Tomohide
    Maternity and Perinatal Care Center, University of the Ryukyus Hospital
  • Ieiri Satoshi
    Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University
  • Takatsuki Mitsuhisa
    Department of Digestive and General Surgery, University of the Ryukyus

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Other Title
  • 沖縄県における過去20年間の先天性横隔膜ヘルニア全治療成績および出生前診断症例に対する重症度分類からみた再評価
  • オキナワケン ニ オケル カコ 20ネンカン ノ センテンセイ オウカクマク ヘルニア ゼン チリョウ セイセキ オヨビ シュッショウマエ シンダン ショウレイ ニ タイスル ジュウショウド ブンルイ カラ ミタ サイヒョウカ

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Abstract

<p>Purpose: We reviewed and analyzed the clinical outcomes of all patients with congenital diaphragmatic hernia (CDH) in Okinawa Prefecture and reevaluated the prenatally diagnosed patients’ severity classification group.</p><p>Methods: Between 2002 and 2021, 61 patients diagnosed with CDH were treated at our institution. Among them, 35 patients who were prenatally diagnosed with isolated left CDH were classified according to Kitano’s and Usui’s classification systems. Information regarding their perinatal status, cardiorespiratory management, and prognosis was retrospectively reviewed. In addition, the results were compared with those from a national survey.</p><p>Results: Extracorporeal membrane oxygenation (ECMO) was administered in 18.0% of patients, 3.3% were unsuitable for surgery, and the overall survival rate was 83.6%. According to Kitano’s classification, 27 patients (77.1%) were classified into Group I; 6 (17.1%), into Group II; and 2 (5.7%), into Group III. Of these 35 prenatally diagnosed patients, 25.7% underwent ECMO, 0% were unable to undergo surgery, and the overall survival was 91.4%. Compared with the nationwide survey results, the prognosis was significantly better in all the patients classified using Kitano’s classification system. In our cohort, ECMO utility and operation rates were significantly higher than those of the national survey. However, the intact discharge rate was lower in our patients, reflecting high complication rates.</p><p>Conclusions: The survival rates in our sample were excellent; this may be because almost all the patients were able to undergo surgery owing to the high frequency of ECMO support. We should aim to reduce postoperative complications and improve long-term quality of life.</p>

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