J.Jpn. Surg. Soc.. 79(9): 1188-1193, 1978

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Report on the annual meeting

BOCHDALEK HERNIAS IN INFANTS: RECENT ADVANCES IN SURGICAL TREATMENT AND LONG-TERM RESULTS

Results of the surgical treatment for Bochdalek hernia were assessed in 347 collected cases from 28 hospitals in Japan. The patients were divided into two groups ; Group A included 88 patients (42 neonates, 33 infants and 13 children) treated between 1960 and 1969. Group B included 257 patients (180 neonates, 46 infants and 31 children) treated from 1970 through 1977.
It seems rather paradoxical to see that the survival rates of Group B is not much better than Group A inspite of the great improvements in surgical technique, anesthesia and intensive care. This can be explained by the fact that in the second series, Group B, many patients were sent to surgeons as a results of great improvements in perinatal medicine. In the past, most of the patients with severe cases died before reacing the hospital. Our investigations support the concept that hypoplastic lungs are fundamental in producing a morbid vicious cycle with respiratory and metabolic acidosis, pulmonary hypertension, right to left ductal and parenchymal shunting, worsening of the hypoxia and acidosis, and progression of the cycle. Management of the patients with Bochdalek hernia before, during and after operation should be along this pathophysiological concept.
Little is known about the long term results of the infants surviving the operation, especially about the respiratory function. In our series, postoperative lung development was studied by means of radioisotope which showed rather impaired development of blood flow in the lung on operated side. Also mobidity of the diaphragma on the operated side showed slight impairment by kymography. Further close investigations should be followed to these cases.

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