Anatomical features of diaphragmatic defects of various sizes and their significance in congenital diaphragmatic hernia in newborns
DOI:
https://doi.org/10.15574/PS.2025.4(89).1520Keywords:
congenital diaphragmatic hernia, congenital diaphragmatic defect, its anatomical features, prognosis, fetus, newborn babyAbstract
Studying the anatomical characteristics of diaphragmatic defects of various types and sizes in congenital diaphragmatic hernia (CDH) is crucial for improving surgical strategies and optimizing treatment for these patients.
Aim - to analyze the anatomical features of diaphragmatic defects of varying sizes in CDH in newborns as a key factor in developing surgical strategies for this congenital malformation.
Materials and methods. We analyzed the anatomical features of diaphragmatic defects of varying sizes in 58 newborns with CDH who were treated between 2013 and 2025. Depending on the size of the diaphragmatic defect, newborns with CD were divided into 2 groups: Group I - 38 (65.5%) infants with small and medium-sized diaphragmatic defects (types A and B), Group II - 20 (34.5%) patients with large and total diaphragmatic defects (types C and D). The following were examined intraoperatively: the side and location of the diaphragmatic defect, the presence of a hernial sac, and the nature of the hernial contents. Herniation was assessed: loops of the small and large intestines, stomach, spleen, pancreas (partially or completely), left/right kidney, liver (partially or completely), greater omentum, gallbladder. Particular attention was paid to the presence of a posterior rim of the diaphragmatic defect.
Results. The mean area of the diaphragmatic defect in patients in Group II was significantly larger than in Group I. No significant differences were found between the groups in the frequency of hernial sac presence or the frequency of left-sided and right-sided diaphragmatic defects. Posterior-lateral localization of the defect was significantly more common in patients in Group I. Posterior-medial localization was observed predominantly in patients in Group II. Partial or complete herniation of the liver and stomach into the thoracic cavity was significantly more common in patients in Group II.
Conclusions. In diaphragmatic defects of types A and B, the location of the CDH is significantly more often posterolateral. The size of the diaphragmatic defect did not influence the side of the CDH, nor the anatomical features of its posterior muscular rim. In large and total diaphragmatic defects, herniation of the stomach and liver into the thoracic cavity occurs significantly more frequently. Studying the anatomical features of diaphragmatic defects of various types and sizes in CDH is of great importance for optimizing the surgical treatment of this critical developmental defect.
The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the aforementioned institution. Informed consent was obtained from patients for the study.
The authors declare no conflict of interest.
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