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Original ArticleOpen Access
Technology Assessment for Management of Congenital Diaphragmatic Hernia : Immediate versus Delayed Surgery
Niramis R 
Background : Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in
pediatric surgery, especially in neonates with symptom presentation within 6 hours after birth. Opinion
regarding the time of surgery has gradually shifted from immediate repair to a policy of stabilization
and delayed repair. Whether delayed surgery is beneficial remains controversial.
Objective : To evaluate the outcomes regarding whether delayed surgical repair improves
survival in CDH neonates, who are symptomatic immediately after delivery, is more beneficial than
immediate surgery.
Material and Method : Data were obtained by searching MEDLINE (1966-2002) and the
Cochrane Database, Issue 2, 2003 using the term "congenital diaphragmatic hernia" and "surgery".
Inclusion criteria were randomized controlled trial (RCT), prospective trial (PT), retrospective analysis
(RA) and meta-analysis (MA). Information from the literature was analyzed by the computer program
ofEpi Info Version 3. Statistical significance was reliable at the level ofp
<
0.05.
Results : Twenty-five studies were obtained and RCT : RA was 2 : 23. Analysis of results of
CDH management revealed that pre-operative stabilization and delayed surgery improved the survival
rate in 14 of 25 in the literature (p
<
0.05), while the remaining 11 articles showed no statistical diffe-
rence of survival between immediate and delayed surgery (p
>
0.05).
Conclusion : From the evidence-based analysis, the results of CDH management between
immediate
versus
delayed surgery were unclear. From the reviewer's experience at the Queen Sirikit
National Institute of Child Health, the strategy of pre-operative stabilization and delayed surgery had
better improved survival of CDH than immediate surgery.
Key word : Congenital Diaphragmatic Hernia, Immediate Surgery, Delayed Surgery
NIRAMIS
pediatric surgery, especially in neonates with symptom presentation within 6 hours after birth. Opinion
regarding the time of surgery has gradually shifted from immediate repair to a policy of stabilization
and delayed repair. Whether delayed surgery is beneficial remains controversial.
Objective : To evaluate the outcomes regarding whether delayed surgical repair improves
survival in CDH neonates, who are symptomatic immediately after delivery, is more beneficial than
immediate surgery.
Material and Method : Data were obtained by searching MEDLINE (1966-2002) and the
Cochrane Database, Issue 2, 2003 using the term "congenital diaphragmatic hernia" and "surgery".
Inclusion criteria were randomized controlled trial (RCT), prospective trial (PT), retrospective analysis
(RA) and meta-analysis (MA). Information from the literature was analyzed by the computer program
ofEpi Info Version 3. Statistical significance was reliable at the level ofp
<
0.05.
Results : Twenty-five studies were obtained and RCT : RA was 2 : 23. Analysis of results of
CDH management revealed that pre-operative stabilization and delayed surgery improved the survival
rate in 14 of 25 in the literature (p
<
0.05), while the remaining 11 articles showed no statistical diffe-
rence of survival between immediate and delayed surgery (p
>
0.05).
Conclusion : From the evidence-based analysis, the results of CDH management between
immediate
versus
delayed surgery were unclear. From the reviewer's experience at the Queen Sirikit
National Institute of Child Health, the strategy of pre-operative stabilization and delayed surgery had
better improved survival of CDH than immediate surgery.
Key word : Congenital Diaphragmatic Hernia, Immediate Surgery, Delayed Surgery
NIRAMIS
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