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Impact of bowel rotation and fixation on obstructive complications in congenital diaphragmatic hernia.
Moskowitzova, Kamila; Zalieckas, Jill M; Sheils, Catherine A; Studley, Mollie; Lemire, Lindsay; Zurakowski, David; Buchmiller, Terry L.
Afiliación
  • Moskowitzova K; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
  • Zalieckas JM; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
  • Sheils CA; Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
  • Studley M; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
  • Lemire L; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
  • Zurakowski D; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
  • Buchmiller TL; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States. Electronic address: Terry.Buchmiller@childrens.harvard.edu.
J Pediatr Surg ; 58(2): 209-212, 2023 Feb.
Article en En | MEDLINE | ID: mdl-36396471
AIM OF THE STUDY: Small bowel obstruction (SBO) is a known complication after congenital diaphragmatic hernia (CDH) repair, which can require surgery and even extensive bowel resection causing short bowel syndrome (SBS). We investigate whether specific bowel rotation and fixation can be used as a predictor for SBO including volvulus. METHODS: A retrospective review of 256 CDH survivors following repair from 2003 to 2020 was performed. Operative notes and upper gastrointestinal series (UGI) were screened to determine the rotation and fixation of the bowel. Primary outcomes included SBO occurrence, SBO treated surgically, and volvulus. For statistical analysis Fisher's exact test was utilized. RESULTS: Twenty-two (9%) patients presented with SBO and majority, 19 (86%), required surgery. Adhesion were observed in 10 (45%), recurrence in 5 (23%), and extensive volvulus leading to SBS in 3 (14%). Both rotation and fixation were recorded in 117 (46%). Presence of left CDH with malrotation and nonfixation was a significant predictor for SBO requiring surgery (P<0.05 vs all other groups). All 3 patients with extensive volvulus had left CDH with nonfixed bowel (100%), however only 1 had malrotation (33%). CONCLUSIONS: Malrotation and nonfixation are associated with increased SBO in CDH. Normal rotation is not protective and patients are still at risk for volvulus resulting in SBS. SBO requiring surgical intervention is common in CDH. Bowel rotation and fixation are important determinants that, should be routinely documented and education about the risk of SBO should be included in family counseling. LEVEL OF EVIDENCE: Level IV - Case Series.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos del Sistema Digestivo / Vólvulo Intestinal / Hernias Diafragmáticas Congénitas / Obstrucción Intestinal Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: J Pediatr Surg Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos del Sistema Digestivo / Vólvulo Intestinal / Hernias Diafragmáticas Congénitas / Obstrucción Intestinal Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: J Pediatr Surg Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos