Pediatric surgery international · 2026
Factors associated with lateral abdominal protrusion after congenital diaphragmatic hernia repair.
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Noguchi Yuki, Sakai Daichi, Takemura Ririko, Yoshida Masayuki, Matsuura Rei, Umeda Satoshi, Usui Noriaki
Аннотация
PURPOSE: Lateral abdominal protrusion (LAP) is observed after congenital diaphragmatic hernia (CDH) repair. We developed an objective radiographic index and explored factors associated with LAP.
METHODS: Seventy-three patients who underwent neonatal CDH repair between 2013 and 2023 were retrospectively evaluated. The standardized LAP index (SLAPI) was developed in the 2013-2018 cohort and validated in the 2019-2023 cohort. Candidate factors available before LAP detection were examined using univariable logistic regression, followed by exploratory Firth logistic regression. Intraobserver reliability was assessed by repeated measurement.
RESULTS: Visually identified LAP occurred in 19 patients (26.0%) at a median age of 35 days. In the development cohort, the SLAPI area under the curve was 1.00 (95% confidence interval [CI], 1.00-1.00). At the prespecified cutoff of ≥ 1.0, sensitivity and specificity were 91.7% and 100% in the development cohort and 100% and 100% in the validation cohort, respectively. In the adjusted analysis, prenatal stomach herniation grade 2-3 (odds ratio [OR], 6.67; 95% CI, 1.62-32.63) and observed-to-expected lung area-to-head circumference ratio per 10-percentage-point increase (OR, 0.54; 95% CI, 0.24-0.96) were associated with LAP. Intraobserver reliability was good (intraclass correlation coefficient, 0.885).
CONCLUSION: SLAPI objectively documented LAP after CDH repair. Its clinical and functional significance requires further study.
METHODS: Seventy-three patients who underwent neonatal CDH repair between 2013 and 2023 were retrospectively evaluated. The standardized LAP index (SLAPI) was developed in the 2013-2018 cohort and validated in the 2019-2023 cohort. Candidate factors available before LAP detection were examined using univariable logistic regression, followed by exploratory Firth logistic regression. Intraobserver reliability was assessed by repeated measurement.
RESULTS: Visually identified LAP occurred in 19 patients (26.0%) at a median age of 35 days. In the development cohort, the SLAPI area under the curve was 1.00 (95% confidence interval [CI], 1.00-1.00). At the prespecified cutoff of ≥ 1.0, sensitivity and specificity were 91.7% and 100% in the development cohort and 100% and 100% in the validation cohort, respectively. In the adjusted analysis, prenatal stomach herniation grade 2-3 (odds ratio [OR], 6.67; 95% CI, 1.62-32.63) and observed-to-expected lung area-to-head circumference ratio per 10-percentage-point increase (OR, 0.54; 95% CI, 0.24-0.96) were associated with LAP. Intraobserver reliability was good (intraclass correlation coefficient, 0.885).
CONCLUSION: SLAPI objectively documented LAP after CDH repair. Its clinical and functional significance requires further study.