Congenital diaphragmatic hernia: operative considerations.

Despite significant changes and improvement in diagnosis and postnatal care, the mortality rate in congenital diaphragmatic hernia (CDH) remains high. Individual surgical series are small and include heterogeneous groups of patients and diverse management strategies. Collected data suggest that delayed repair, and repair performed on extracorporeal membrane oxygenation (ECMO) may confer a survival advantage. As the timing of surgery has changed, so have the techniques required for successful operative repair. The use of ECMO has required modification in operative techniques to respond to altered coagulation. Surgical conduct directly effects morbidity and mortality rates, and our experience in managing the last 53 patients (1989 through 1995) has led to new operative protocols that have reduced complications. The details of operative repair and strategies to reduce postoperative hemorrhage and recurrence are emphasized.