Congenital Anomalies of the Diaphragm in Children.

Twenty children with various diaphragmatic anomalies, managed over a period of 3 years, are presented, These included congenital diaphragmatic hernia (CDH 10), congenital eventration of diaphragm (CDE 6) and hiatus hernia with gastro-esophageal reflux (HH-GER 4). Clinical presentation of these children was: respiratory distress (7), recurrent repiratouy tract infection with failure to thrive (11) and gastric volvulus (3). Two patients of gastric volvulus had acute surgical abdomen. The patients in respiratouy distress group were all newborns with CDH. Whereas, those who had gastric volvulus were CDE 2 and HH-GER 1. All children were operated through left subcostal transabdominal approach, except those with HH-GER who were explored through upper midline incision. Repair of diaphragmatic defect/placation was done in patients with CDH/CDE, whereas Nissen fundoplication (Loode wrap) was done in patients of HH-GER. Three newborns with CDH and one child with CDE and gastric volvulus died. All other 16 surviving children are doning well after 4 months to 3 years of follow up.