Risk factors for recurrence of congenital diaphragmatic hernia in the era of minimally invasive surgery.

PURPOSE: To elucidate the long-term incidence and risk factors of congenital diaphragmatic hernia (CDH) recurrence in the era of minimally invasive surgery (MIS).

METHODS

In a Japanese CDH Study Group database between 2006 and 2023, we included 1,115 patients with CDH who underwent surgery for diaphragmatic repair, with follow-up data available for up to 12 years of age. The following variables were assessed as potential risk factors for recurrence: right-sided hernia, large diaphragmatic defect (international classification C and D), liver herniation, stomach herniation, patch use, and MIS without conversion.

RESULTS

A total of 134 recurrences occurred in 98 patients. The cumulative recurrence rate was 11.4% at 10 years of age. In multivariate analyses, large diaphragmatic defect (adjusted odds ratio [OR], 2.26; 95% confidence interval [CI], 1.14-4.47), liver herniation (adjusted OR, 2.39; 95% CI, 1.27-4.47), and MIS without conversion (adjusted OR, 2.56; 95% CI, 1.19-5.50) were significant risk factors. In patients with both non-large diaphragmatic defects and non-liver herniation, the cumulative incidence of recurrence was significantly higher for MIS than for open surgery (p = 0.0288). Patch use was significantly more common in open surgery than in MIS without conversion (45% vs. 18%, p < 0.0001), especially in patients with international classification C diaphragmatic defects (84% vs. 27%, p < 0.0001).

CONCLUSION

Herein, the recurrence rate was 11.4%. A large defect size, liver herniation, and MIS without conversion were independent risk factors for CDH recurrence. In MIS for severe CDH, aggressive patch use and appropriate conversion to open surgery may mitigate recurrence.