Clinical and radiological characteristics of surgically repaired versus unrepaired congenital diaphragmatic eventration in children

There is no agreed upon criteria for repairing congenital diaphragmatic eventration (DE) in children due to variation in clinical presentation and lack of outcome studies. We retrospectively compared clinical and radiological characteristics of surgically repaired versus non-repaired children with congenital DE from a single center during 2018-2024. We also compared pre- versus post-repair in the repaired patients. Diaphragm elevation was defined as the ratio of affected diaphragm over non-affected diaphragm heights by chest x ray. Thirty-six patients (24 males and 12 females) were included. Median (IQR) age at diagnosis was 3 (0.9 -17.8) months. Twenty (56 %) patients were symptomatic. Comorbidities were reported in 18 (47 %) patients. DE was right-sided in 23 (64 %), left-sided in 11(31 %), and bilateral in 2 (6 %) patients. Twelve (33 %) patients required surgical plication. Plication was performed via thoracotomy in 5 (42 %), laparotomy in 4 (33 %) and thoracoscopy in 3(25 %) patients. Post-surgical complications included infection in 2 (17 %), and pneumothorax in 2 (17 %) patients. There was no significant difference between repaired and non-repaired patients in diaphragm elevation (P = 0.85). However, surgically repaired patients were more likely to be symptomatic, have comorbidities, require hospitalization and respiratory support (P = 0.002, P = 0.01, P = 0.0002, P = 0.0003, respectively). Diaphragm elevation post-repair improved from 0.69 (0.6-0.75) to 0.96 (0.89-0.98), P<0.001. However, there was no improvement post repair in respiratory support, PICU stay, or hospital stay. Conclusion: Diaphragmatic eventration is more likely to be repaired in symptomatic, hospitalized children with comorbidities. Surgical repair resulted in radiological improvement but no clinical improvement.