Timing of surgical intervention in congenital diaphragmatic hernia based on preoperative stabilization criteria: a case-based report

Abstract

Background: Congenital diaphragmatic hernia (CDH) is a developmental defect that allows abdominal organs to herniate into the thoracic cavity, leading to pulmonary hypoplasia and persistent pulmonary hypertension (PH). Mortality is largely driven by cardiopulmonary failure rather than the diaphragmatic defect itself. Modern management emphasizes physiological stabilization prior to surgical repair, recognizing CDH as an urgent but not emergent condition.

Case Presentation: We report two neonates with left-sided CDH who underwent surgical repair after meeting predefined preoperative stabilization criteria. The first case involved a term neonate with mild–moderate PH who achieved adequate oxygenation, ventilation, and acid–base balance after 24 hours of stabilization. The second case involved a preterm neonate with respiratory distress syndrome and cardiac comorbidities (PDA and PFO) who similarly met stabilization targets before surgery. Both patients received general anesthesia using opioid-based analgesia and lung-protective ventilation. Surgical repair proceeded without intraoperative complications, and postoperative intensive care demonstrated improved respiratory and hemodynamic stability.

Discussion: Pulmonary hypoplasia and PH are the principal determinants of CDH outcomes. Delaying repair until normalization of acid–base status, adequate oxygenation, and controlled pulmonary pressures are achieved reduces perioperative risk. Careful anesthetic management and multidisciplinary coordination are essential to prevent pulmonary hypertensive crises and maintain cardiopulmonary stability.

Conclusion: Surgical timing in CDH should be guided by physiological readiness rather than immediate anatomical correction. Protocol-based preoperative stabilization supports safer anesthesia and improved postoperative recovery.

Keywords: Congenital diaphragmatic hernia; LUNG-protective ventilation; Preoperative stabilization; Pulmonary hypertension; Neonatal anesthesia; Surgical timing

Citation: Walla NN, Giwangkancana GW, Sudjud RW. Timing of surgical intervention in congenital diaphragmatic hernia based on preoperative stabilization criteria: a case-based report. Anaesth. pain intensive care. 2026;30(5): 673-676. DOI: 10.35975/apic.v30i5.3249

Received: February 23, 2026; Revised: May 06, 2026; Accepted: May 08, 2026