Congenital diaphragmatic eventration: Should we maintain surgical treatment? A retrospective multicentric cohort study.

Background: Congenital diaphragmatic eventration (CDE) is an infrequent congenital pathology without consensus of treatment. This study assessed current care practices for this pathology in children in France. Methods: Retrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age followed for CDE since 2010. Patients with surgical or conservative treatment were compared. Results: 139 patients were included, with a median age of 8 [1 to 16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. It was symptomatic in 65% of the cases, with a respiratory component for 97% of these patients. The primary indication for treatment, essentially depending on the clinical respiratory impairment and the level of the diaphragm, was surgery for diaphragmatic plication in 87 cases (62%) or clinical follow-up for the 52 others, 25 of whom were operated on secondarily. There were 32 early per- or postoperative complications (29%), and 8 recurrences of eventration (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome fell from the 6th to the 9th back rib, and the rate of respiratory symptoms from 64% to 14%, in both surveyed and surgically treated patients. Conclusions: CDE is mainly diagnosed in newborn or infant boys and right-sided. Diaphragmatic plication may be the best treatment in symptomatic patients with a dome level upper the 6th posterior rib, but exposes them to a 29% complication rate and 7% of recurrence. ClinicalTrials [NCT04862494][1], April 28, 2021. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of the university hospital of Angers gave ethical approval for this work (ref 2021-013). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04862494&atom=%2Fmedrxiv%2Fearly%2F2024%2F01%2F25%2F2024.01.25.24301768.atom