Intraoperative surgical complications of open surgery for congenital diaphragmatic hernia: A multicenter, observational study in Japan

Abstract Purpose: This study aimed to clarify surgical complications associated with open surgery for congenital diaphragmatic hernia (CDH). Methods: We performed an exploratory data analysis of the clinical characteristics of surgical complications of neonates with CDH who underwent laparotomy or thoracotomy between 2006 and 2021. Data of these patients were obtained from the database of the Japanese CDH Study Group. Results: Among 1,111 neonates with left or right CDH, 852 underwent open surgery (laparotomy or thoracotomy). Of these 852 neonates, 51 had the following surgical complications: organ injury (n=48; 6% of open surgeries); circulatory failure caused by changes in the organ location (n=2); and skin burns (n=1). Injured organs included the spleen (n=30; 62% of organ injuries), liver (n=7), lungs (n=4), intestine (n=4), adrenal gland (n=2), and thoracic wall (n=2). Fourteen of the patients who experienced organ injury required a blood transfusion (2% of open surgeries). The adjusted odds ratio of splenic injury for patients with non-direct closure of the diaphragm was 2.2 (95% confidence interval, 1.1–4.9). Conclusion: Of the patients who underwent open surgery for CDH, 2% experienced organ injury that required a blood transfusion. Non-direct closure of the diaphragmatic defect was a risk factor for splenic injury.