A growing body of literature suggests that the presence of a hernial sac (HS) in newborns with congenital diaphragmatic hernia (CDH) may improve prognosis. By examining a large cohort of CDH babies admitted to our centre we aimed to establish if the presence of HS is a robust independent predictor of improved survival.
All CDH patients admitted to a single centre were recruited. Post neonatal presentation and Morgagni hernias were excluded. Demographics, defect type, laterality, survival and recurrence were recorded.
192 CDH cases were managed in a 20 year period during 1997 - 2017. Ten babies had Morgagni hernia and 29 remaining cases diagnosed beyond the neonatal period were excluded. Analysis was undertaken in 153 newborns with Bochdalek hernia. There were 53 females giving a statistically significant male to female preponderance with a ratio of 1.89 (p = 0.0002 , Binomial test). Twenty two (14%) newborns had a HS. Survival with a HS was 21/22 (95%) vs 108/131 (82%) without HS ; non significant (p = 0.20, Fisher's Exact Test). No difference(s) in HS incidence were identified by sex (M:F 15% vs 13.2%, p = 0.81, Fisher's Exact Test). Subgroup analysis according to gender found the presence of HS showed a consistent trend towards improved overall survival in both sexes (100% vs 87% in females, 93% vs 80% in males ).
Like early published studies recording a significant survival advantage with the presence of a HS we herein demonstrate a trend towards improved survival for CDH patients with a HS. These findings were also consistent between sexes. Future multicentre studies and registry(s) may provide additional data to fully answer this hypothesis.