Congenital diaphragmatic hernia (CDH) remains one of the leading causes of high neonatal mortality and morbidity despite advances in prenatal diagnosis and intensive care [Cordier, Anne-Gael, et al., 2020]. Mortality rates range from 10–35% and for large defects such as agenesis (type D) they reach 40–70%, even in specialized centers, highlighting the need for improved treatment approaches [Gupta, Vikas S., et al., 2021].
The prognosis is determined by the degree of pulmonary hypoplasia the size of the defect and the presence of associated anomalies which are observed in 40% of cases [Macchini, Rafaelli, et al., 2022]. Prenatal indices are often insufficiently effective complicating pregnancy management [Basurto, David, et al., 2019]. The use of advanced imaging modalities, such as ultrasound and MRI, significantly improves diagnostic accuracy yet their application requires further optimization [Zani, Augusto, et al., 2022].
Surgical treatment remains a key stage in managing CDH. Minimally invasive techniques (thoracoscopy) are applied in 30% of cases with defects of types A and B whereas laparotomy and thoracotomy remain the standard approaches in severe conditions [Budzanowski, Annita, et al., 2023]. The high frequency of complications and recurrences associated with large defects (types C and D) necessitates further improvement of surgical techniques [Cioci, Urrechaga, et al., 2022; Kryvchenia, Rudenko, 2022].
Despite advancements in various criteria and methodologies the selection of an optimal surgical approach and an effective repair technique for CDH, particularly in high-risk patients, remains a subject of ongoing discussion.
Aim of the study:
To improve treatment outcomes in children with CDH by enhancing diagnostic approaches and optimizing surgical repair techniques through the application of the thoracalization concept of the abdominal cavity.
Objectives of the study:
1. Optimize prenatal diagnosis of CDH by developing a comprehensive survival prognostic index for newborns based on modern imaging techniques.
2. Conduct a comparative analysis of surgical approaches for CDH repair to determine their priority and effectiveness.
3. Identify independent prognostic factors of postoperative mortality in patients with CDH.
4. Improve the surgical method for repairing large diaphragmatic defects by applying the principle of thoracalization of the abdominal cavity.
5. Evaluate the outcomes of the improved surgical method for repairing large diaphragmatic defects in newborns.
