J Pediatr Surg
. 2026 Feb 5:163005.
doi: 10.1016/j.jpedsurg.2026.163005. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41654172/
Impact of Hernia Sac in Congenital Diaphragmatic Hernia: Associations with Morbidity and Mortality
Krysta M Sutyak 1, Kylie I Holden 2, Charles Green 3, Matthew T Harting 2, KuoJen Tsao 4, Kouji Nagata 5, Richard Keijzer 6, Marietta Jank 6, Tim Jancelewicz 7, Joseph T Church 8, Pamela A Lally 2, Kevin P Lally 4; For, The Congenital Diaphragmatic Hernia Study Group
Affiliations Expand
- PMID: 41654172
- DOI: 10.1016/j.jpedsurg.2026.163005
Abstract
Introduction: The impact of hernia sac (HS+) on outcomes in congenital diaphragmatic hernia (CDH) when accounting for defect size is unknown. In a multicenter analysis, considering defect size, we aim to delineate the association of HS+ and morbidity and mortality.
Methods: A retrospective analysis of CDH Study Group (2007-2024) data was performed. Demographics, defect characteristics, morbidity, and mortality were abstracted. Multilevel regression and parallel Bayesian analysis were performed on 80% of the data, tested on 20% hold-out data, and reported in area under the curve (AUC).
Results: 7,828 operative CDH patients were included. HS+ in 20%; most common in A and B defects (24%, 25%), decreasing in C and D defects (17%, 7%); present in a greater proportion of right-sided defects (30% vs 18%, p<.001). On multilevel logistic regression, with random effects for center, controlling for birth weight, major cardiac abnormalities, chromosomal anomaly, utilization of ECLS, side of the defect, CDHSG A-D, HS+ was not associated with survival (OR 1.19, 95% CI 0.92-1.53). On Bayesian analysis the OR of HS+ on survival was 1.07 (95% credible interval 0.87-1.36). HS+ was not associated with pulmonary hypertension (OR 0.97, 95% CI 0.82-1.14) or cardiac dysfunction at birth. HS+ was associated with a reduction in ECLS utilization (OR 0.60, 95% CI 0.48-0.74), oxygen status at 30 days (OR 0.56, 95% CI 0.44-0.70), length of mechanical ventilation (IRR 0.84, 95% CI 0.79-0.89), and length of hospital stay (IRR 0.92, 95% CI 0.88-0.96).
Conclusion: HS+ is not associated with increased survival, with a neutral Bayesian probability of benefit. However, morbidity outcomes were improved in HS+ patients.
Keywords: CDH Study Group; Congenital Diaphragmatic Hernia; Hernia Sac; Morbidity; Mortality.
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