Long-Term Evaluation of Gastroesophageal Reflux in Neonates with and without Preventive Anti-reflux Surgery at the Time of Congenital Diaphragmatic Hernia Repair

Abstract

One potential comorbidity after congenital diaphragmatic hernia (CDH) is gastroesophageal reflux (GER), which can have a substantial effect on patients’ quality of life, thriving, and complications later in life. Efforts have been made to reduce gastroesophageal reflux with a preventive anti-reflux procedure at the time of CDH repair. In this follow-up study of neonates participating in a primary RCT study on preventive anti-reflux surgery, symptoms of GER were assessed longitudinally. Long-term data with a median follow-up time of ten years was available in 66 patients. Thirty-one neonates received an initial fundoplication. Secondary anti-reflux surgery was necessary in 18% and only in patients with large defects. It was required significantly more often in patients with intrathoracic herniation of liver (p = 0.015) and stomach (p = 0.019) and patch repair (p = 0.03). Liver herniation was the only independent risk factor identified in multivariate regression analysis. Primary fundopexy and hemifundoplication did not reveal a protective effect regarding the occurrence of GER symptoms, the need for secondary antireflux surgery or the gain of body weight regardless of defect size neither in the short nor in the long term. Symptoms of GER must be assessed carefully especially in children with large defects, as these are prone to require secondary anti-reflux surgery in the long-term. Routine evaluation of GER including endoscopy and impedance measurement should be recommended especially for high-risk patients.

Long-term follow-up of patients with congenital diaphragmatic hernia

“…84 Even more challenging is determining the role of fundoplication to improve growth, prevent respiratory infections and manage esophagitis. 78 79 85 86 Prospective evaluation of concomitant fundoplication at time of CDH repair did not show a significant reduction in GERD symptoms in patients who underwent fundoplication compared with controls. Similarly, no difference in growth parameters was achieved at 2 years of age when comparing neonates who underwent fundoplication to controls.…”

“…85 One of the largest studies from the French CDH Registry of over 700 neonates identified intrathoracic liver position, larger CDH defect size, prenatal diagnosis, and patch repair as predictive variables for fundoplication. 78 As an alternative to fundoplication to manage GERD, postpyloric tube feeding has been used in some centers.…”

Long-Term Evaluation of the Shape of the Reconstructed Diaphragm in Patients with Left-Sided Congenital Diaphragmatic Hernia Using Serial Chest Radiographs and Correlation to Further Complications

“…Treating congenital diaphragmatic hernia (CDH), a rare and potentially life-threatening malformation of a newborn's diaphragm and lungs, does not end with surgical repair and patient discharge. Long-term morbidity in these patients is a well-known problem, especially in those with large defects [1,2]. As survival rates of patients with large defects increase, so does the need for a thorough follow-up accompanying these patients into transition and adulthood [3][4][5][6].…”