Tedavi
Özet
Konjenital diyafram hernisi (KDH), pulmoner hipoplazi ve pulmoner hipertansiyonla seyreden, multidisipliner yaklaşım gerektiren ciddi bir neonatal anomalidir. Cerrahi başarının en önemli belirleyicisi, ameliyat öncesi dönemde sağlanan hemodinamik ve solunumsal stabilizasyondur. Bu süreçte nazik ventilasyon stratejileri, pulmoner hipertansiyonun kontrolü, minimal sıvı yüklemesi ve gastrointestinal dekompresyon temel ilkeleri oluşturur. Cerrahi tedavide amaç, herni kesesinin eksizyonu ve defektin primer veya yama ile onarımıdır. Defekt boyutu, onarım tekniği ve kullanılan materyalin biyomekanik özellikleri uzun dönem prognozu etkiler. Minimal invaziv yaklaşımlar seçilmiş olgularda avantaj sağlamakla birlikte nüks oranları defekt genişliği ve cerrah deneyimine bağlı olarak değişkenlik gösterir. Ameliyat sonrası dönemde pulmoner hipertansiyon yönetimi, akciğer koruyucu ventilasyon, sıvı-elektrolit dengesi, enfeksiyon ve nörolojik izlem kritik öneme sahiptir. Nüks herni, reflü, skolyoz ve büyüme geriliği uzun dönem takipte sık karşılaşılan problemlerdir. Tüm süreçte fizyolojik dengeyi önceleyen, hasta bazlı stratejilerin uygulanması mortaliteyi azaltmada temel faktördür.
Referanslar
Harting MT, Hollinger LE, Lally KP. Holcomb and Ashcraft’s Pediatric Surgery. Edinburgh: Elsevier; 2020:377–402.
Morini F, Lally KP, Lally PA, et al. Treatment strategies for congenital diaphragmatic hernia. Front Pediatr. 2017;5:195.
Başaklar AC. Bebek ve Çocukların Cerrahi ve Ürolojik Hastalıkları. Palme Yayıncılık; 2006:273–309.
Chandrasekharan PK, Rawat M, Madappa R, et al. Congenital diaphragmatic hernia - a review. Matern Health Neonatol Perinatol. 2017;3:6.
Boloker J, Bateman DA, Wung JT, Stolar CJH. Congenital diaphragmatic hernia in 120 infants treated without hyperventilation or alkalosis. J Pediatr Surg. 2002;37:357–366.
Lally KP, Lally PA, Langham MR, et al. Standardized management of CDH: impact on survival. J Pediatr Surg. 1998;33:1015–1019.
Okuyama H, Kubota A, Oue T, et al. Clinical experience with delayed surgery for CDH. J Pediatr Surg. 2002;37:1102–1105.
Morini F, Capolupo I, Casaccia G, et al. Extracorporeal membrane oxygenation in CDH: a review. Pediatr Surg Int. 2015;31:125–131.
Van den Hout L, Reiss I, Felix JF, et al. Risk factors for chronic lung disease and mortality in CDH: outcome of 200 patients. Pediatrics. 2010;126:e494–e500.
Van Meighem T, Done E, Gucciardo L, et al. Perinatal strategies in the management of CDH. Prenat Diagn. 2016;36:1151–1158.
Okuyama H, Kubota A. Pulmonary hypertension in congenital diaphragmatic hernia. Pediatr Surg Int. 2017;33:367–376.
Steinhorn RH. Neonatal pulmonary hypertension. Pediatr Crit Care Med. 2010;11:S79–S84.
Kinsella JP, Ivy DD, Abman SH. Pulmonary vasodilator therapy in persistent pulmonary hypertension of the newborn. Clin Perinatol. 1995;22:517–528.
Wung JT, James LS, Kilchevsky E, et al. Management of infants with CDH using gentle ventilation and permissive hypercapnia. J Pediatr Surg. 1995;30:406–409.
Reiss I, Schaible T, van den Hout L, et al. Standardized postnatal management of infants with CDH in Europe: the CDH EURO Consortium Consensus. Neonatology. 2010;98:354–364.
Bohn D. Pulmonary hypertension in CDH: pathophysiology and treatment. J Pediatr Surg. 1999;34:294–299.
Lally KP, Engle W, and the CDH Study Group. Guidelines for CDH management. Pediatrics. 2014;134:e964–e970.
Frenckner B, Bagolan P, Deprest J. CDH and ECMO: current status and future directions. Semin Fetal Neonatal Med. 2014;19:364–371.
Downard CD, Jaksic T, Garza JJ, et al. Analysis of an improved survival rate in patients with CDH. J Pediatr Surg. 2003;38:729–732.
Bairdain S, Fell SC, Wilson JM. Timing of repair and survival in neonates with CDH on ECMO. J Pediatr Surg. 2015;50:1866–1869.
Stolar CJH, Dillon PW, Reyes C. Selective use of ECMO in CDH. J Pediatr Surg. 1988;23:207–211.
Lally KP, Lally PA. Pediatric Surgery Study Group CDH Consensus Report. 2022.
Bagolan P, Morini F. Long-term follow-up of congenital diaphragmatic hernia survivors. Semin Pediatr Surg. 2007;16:134–144.
Kays DW. Surgical management of congenital diaphragmatic hernia. Clin Perinatol. 1996;23:625–641.
Puri P, Hollwarth ME. Pediatric Surgery. Springer; 2023:463–475.
Tsao K, Lally KP. Patch repair of large congenital diaphragmatic hernia. Semin Pediatr Surg. 2008;17:151–157.
Chen C, Koivusalo A, Laitinen J, et al. Recurrence and long-term results after patch repair of CDH. J Pediatr Surg. 2015;50:1859–1865.
Gupta VS, Kim HB. Use of biologic mesh in congenital diaphragmatic hernia repair. Semin Pediatr Surg. 2011;20:167–171.
Perrone EE, et al. Comparison of biologic and synthetic patch repairs in a CDH model. J Pediatr Surg. 2013;48:1206–1212.
Puapong D, et al. Comparison of Gore-Tex and SIS patch repairs in infants with CDH. J Pediatr Surg. 2008;43:81–86.
Bairdain S, et al. Muscle flap repair for recurrent CDH. J Pediatr Surg. 2013;48:1172–1176.
Zamora IJ, et al. Clinical outcomes following autologous tissue repair in CDH. Pediatr Surg Int. 2016;32:405–412.
Van der Veer M, et al. Minimally invasive repair of CDH: a systematic review. Surg Endosc. 2015;29:2971–2984.
Liem NT, et al. Laparoscopic repair in neonates with CDH. J Laparoendosc Adv Surg Tech A. 2014;24:852–857.
Grethel EJ, et al. Thoracoscopic repair and recurrence in CDH. J Pediatr Surg. 2009;44:1841–1845.
Puligandla PS, Skarsgard ED. Complications in minimally invasive repair of CDH. Pediatr Surg Int. 2012;28:1095–1100.
Chiu PP, et al. Outcome after thoracoscopic repair of CDH: systematic review and meta-analysis. J Pediatr Surg. 2010;45:1343–1351.
Bagolan P, et al. Postoperative complications and follow-up of CDH. Pediatr Surg Int. 2004;20:763–767.
Morini F, et al. Recurrence after CDH repair: risk factors and management. Eur J Pediatr Surg. 2013;23:388–393.
Kitano Y, et al. Pathophysiology of recurrent CDH and prevention strategies. Pediatr Surg Int. 2009;25:589–595.
Fauza DO. Tissue engineering in CDH: experimental and clinical aspects. Semin Pediatr Surg. 2014;23:117–123.
Kuo CJ, et al. Long-term follow-up after bioengineered patch repair of CDH. J Pediatr Surg. 2017;52:177–183.
Kim S, et al. Robotic surgery in pediatric diaphragmatic repair: current status. J Robot Surg. 2020;14:749–757.
Coppola CP, et al. Postoperative management in congenital diaphragmatic hernia. J Pediatr Surg. 2014;49:1653–1659.
Raffensperger JG. Surgery of Infants and Children. Philadelphia: Saunders; 1979.
Reynolds M, et al. Postoperative respiratory care in CDH. Pediatr Clin North Am. 1990;37:147–156.
Gibson J, et al. Ventilation strategies after CDH repair. Clin Perinatol. 1983;10:299–312.
Srouji MN, et al. Pulmonary hypertension in CDH: postoperative management. J Pediatr Surg. 1981;16:406–411.
Kinsella JP, Ivy DD. Pulmonary vasodilator therapy in newborns. Clin Perinatol. 1995;22:517–528.
Morini F, et al. Gastrointestinal outcomes after CDH repair. Eur J Pediatr Surg. 2013;23:388–393.
Downard CD, et al. Pain control and outcomes after CDH surgery. J Pediatr Surg. 2003;38:729–732.
Bagolan P, Morini F. Long-term follow-up of congenital diaphragmatic hernia survivors. Semin Pediatr Surg. 2007;16:134–144.
