Technology Assessment for Management of Congenital Diaphragmatic Hernia : Immediate versus Delayed Surgery
RANGSAN NIRAMIS, MD*
Affiliation : *Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
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.
Materials and Methods : 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.
Keywords : Congenital Diaphragmatic Hernia, Immediate Surgery, Delayed Surgery
