Recurrent diaphragmatic hernia: not such a rarity

ABSTRACT

Survivors of congenital diaphragmatic hernia usually do well, but a large number of them have significant morbidity on follow-up. Recurrent diaphragmatic hernia is one of the long term complications that is not fully addressed because of lack of reporting. Over a period of 8 years from 1989 to 1997, we treated 41 children with different types of congenital diaphragmatic hernia. Five of these patients were subsequently seen with recurrent hernia. The charts of these patients were retrospectively reviewed to identify the causes of recurrence, mode of presentation and methods of treatment. Out of the 41 children with different types of congenital diaphragmatic hernia that we treated, 25 of them survived. There were 5 recurrences [3 males and 2 females], among these 25 cases, an incidence of 25%. The interval from initial repair to the presentation with recurrence was variable from 7 days in one to 15 months [mean 7.7 months]. All were symptomatic except one who presented with right sided pneumonia and on chest x-ray was found to have a recurrent hernia on the other side. One of our patients presented with acute respiratory distress and was found to have a recurrent left sided diaphragmatic hernia with stomach herniation and intrathoracic gastric volvolus. In all patients the hernial defect was large except in one patient with Morgagni's hernia. In all patients silk was used to close the defect except in one where Vinyl was used. In 2 patients with congenital anterolateral diaphragmatic defects, there were hernial sacs that were not excised in one and only excised partially in the other. Recurrent diaphragmatic hernia is not a rarity. Post to diaphragmatic hernia repair, these patients should be followed up and since some of these recurrences are asymptomatic they should have biannual chest x-rays. Only non absorbable sutures should be used in the repair of the defects and where there is a hernial sac it should be excised totally prior to the repair. To obviate the danger of incarceration and strangulation, recurrent diaphragmatic hernias should be repaired