Congenital diaphragmatic eventration: Should we maintain surgical treatment? A retrospective multicentric cohort study

Abstract

AbstractBackgroundCongenital diaphragmatic eventration (CDE) is an infrequent congenital pathology without consensus of treatment. This study assessed current care practices for this pathology in children in France.MethodsRetrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age followed for CDE since 2010. Patients with surgical or conservative treatment were compared.Results139 patients were included, with a median age of 8 [1 – 16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. It was symptomatic in 65% of the cases, with a respiratory component for 97% of these patients. The primary indication for treatment, essentially depending on the clinical respiratory impairment and the level of the diaphragm, was surgery for diaphragmatic plication in 87 cases (62%) or clinical follow-up for the 52 others, 25 of whom were operated on secondarily. There were 32 early per- or postoperative complications (29%), and 8 recurrences of eventration (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome fell from the 6th to the 9th back rib, and the rate of respiratory symptoms from 64% to 14%, in both surveyed and surgically treated patients.ConclusionsCDE is mainly diagnosed in newborn or infant boys and right-sided. Diaphragmatic plication may be the best treatment in symptomatic patients with a dome level upper the 6thposterior rib, but exposes them to a 29% complication rate and 7% of recurrence.ClinicalTrialsNCT04862494, April 28, 2021.What’s new?Boys are indeed more affected than girls (68.3%), but left-side eventration only happens in 33% of cases.As compared to conservative management, surgery may be positively associated with diaphragmatic level improvement, but not with long term resolution of symptoms.