The presence of a hernia sac in congenital diaphragmatic hernia is associated with better fetal lung growth and outcomes

J Pediatr Surg. 2013 Jun;48(6):1165-71. doi: 10.1016/j.jpedsurg.2013.03.010.


Purpose: The purpose of this study was to evaluate the relationship between the presence of a hernia sac and fetal lung growth and outcomes in infants with Congenital, Diaphragmatic Hernia (CDH).

Methods: The medical records of all neonates with CDH treated in our institution between 2004 and 2011 were reviewed. The presence of a hernia sac was confirmed at the time of surgical repair or at autopsy. Data were analyzed using parametric and non-parametric tests where appropriate. Multivariable regression and survival analyses were applied.

Results: Of 148 neonates treated for CDH, 107 (72%) had isolated CDH and 30 (20%) had a hernia sac. Infants with a hernia sac had significantly lower need for ECMO, patch repair, supplemental oxygen at 30 days of life, and shorter duration of mechanical ventilation and hospital stay. Ninety-three patients had prenatal imaging. The mean observed-to-expected total fetal lung volume in the sac group was higher throughout gestation. Although a greater percentage of sac patients had liver herniation as a dichotomous variable, the amount of herniated liver (%LH and LiTR) was significantly lower in the presence of a hernia sac.

Conclusion: The presence of a hernia sac in Congenital Diaphragmatic Hernia is associated with less visceral herniation, greater fetal lung growth, and better post-natal outcomes.

Keywords: CDH; Congenital diaphragmatic hernia; Fetal lung volumes; Fetal magnetic resonance imaging; Hernia sac; Morbidity; Mortality; Prenatal diagnosis.

Publication types

  • Evaluation Study

MeSH terms

  • Cohort Studies
  • Combined Modality Therapy
  • Extracorporeal Membrane Oxygenation
  • Female
  • Fetal Organ Maturity*
  • Hernia, Diaphragmatic / embryology
  • Hernia, Diaphragmatic / mortality
  • Hernia, Diaphragmatic / pathology
  • Hernia, Diaphragmatic / therapy
  • Hernias, Diaphragmatic, Congenital*
  • Herniorrhaphy
  • Humans
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • Linear Models
  • Logistic Models
  • Lung / embryology*
  • Male
  • Multivariate Analysis
  • Pregnancy
  • Prenatal Diagnosis
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome