Preoperative sonographic evaluation of the defect size and the diaphragm rim in congenital diaphragmatic hernia — preliminary experience

Background Sonographic assessment before congenital diaphragmatic hernia repair has rarely been studied. Objective To evaluate the accuracy of preoperative ultrasound in measuring the defect size and in anticipating the presence of a rim and thereby to determine ultrasound’s usefulness in informing the surgical approach for definitive repair of congenital diaphragmatic hernia. Materials and methods We performed a retrospective review of the medical records of seven children with left congenital diaphragmatic hernia who had undergone ultrasound and definitive repair between 2014 and 2017 at our institution. Results The estimated defect size by ultrasound to the actual defect size measured intraoperatively for each case were as follows: 23 × 25 mm to 20 × 26 mm (case 1); 23 × 30 mm to 20 × 30 mm (case 2); 43 × 25 mm to 30 × 30 mm (case 3); 21 × 23 mm to 20 × 25 mm (case 4); 19 × 24 mm to 10 × 30 mm (case 5); 32 × 33 mm to 30 × 50 mm (case 6); and almost total absence to 40 × 50 mm (case 7). Presence or absence of each part of the diaphragm rim evaluated by ultrasound was almost identical with the actual intraoperative findings. According to the ultrasound findings, we performed a successful thoracoscopic repair in cases 1–5 with relatively small defects and presence of all parts of the rim or absence of only posterolateral rim. Conclusion There was good concordance between ultrasound findings and operative findings regarding the size of the defect and presence or absence of the diaphragm rim.