Late-presenting of Bochdalek Hernia in Children: A single-center experience study
Authors: Arslan Serkan , Okur Mehmet Hanifi , Azizoğlu Mustafa , Basuguy Erol , Aydoğdu Bahattin , Akbudak İbrahim , Ciğdem Murat Kemal , Onen Abdurrahman , Otcu Selcuk 
Published: December 2022

Abstract
Aim: The objective of this study was to develop an algorithm by investigating the clinical characteristics of late-presenting BH, diagnostic and therapeutic strategies, and the results of other anomalies.
Materyal ve Metods: Patients with Late-presenting BH over 1 month between 1983-2022 were included in the study. Patients with late-presenting BH were first filmed with Chest X-rays. Then computarized tomography (CT) or Up-Low gastrointestinal system (GİS) series was taken, if needed. The algorithm gives detailed information on which patients underwent CT or Up-Low GİS series scans. We recorded the following data: age, sex, side of herniation, presenting symptoms and signs, associated anomalies, radiographic findings, intraoperative findings, postoperative course, complications, and mortality. Right and left late-presenting BH were compared according to various parameters. Patients who underwent open surgery and minimally invasive surgery (MIS) were compared. Parameters were compared according to age. The groups were compared in terms of age, gender, side, malrotation, additional anomaly, symptom times, surgical method, and results.
Results: In our study, there were 175 BH patients. 129 of these patients were excluded from the study because they had neonatal early-presenting BDH. The data of 46 of these patients were accessed and analyzed. In our study, 26% of all diaphragmatic hernias were Late-presenting of BD. While this rate was higher in our study before 2005, it has decreased in recent years due to the development of imaging methods. There were 26 (57%) males and 20 (43%) females among these patients. While the patients' mean age was 14.7 months (1 month-14 years), 39 (85%) were on the left side and 7 (15%) were on the right side. The most common symptom was respiratory problems. Respiratory symptoms were detected more frequently on the right than on the left. GIS symptoms were more common on the left. Right late-presenting BDH was not statistically significant due to the small number of patients (p>0.05). When various parameters of patients with right and left late-presenting BDH were compared, no significant difference was found in both groups (p>0.05). Age was compared with symptoms. No significant difference was found (p>0.05).Chest X-rays were performed on 46 patients. In some suspicious cases on Chest X-rays and for the differential diagnosis of other pathologies, 33% of the patients were performed for CT scan and 20% for Up-Low GIS Series. Laparotomy was performed in 39 (85%) of the patients, and minimally invasive surgery was performed in 7 (15%). The thoracoscopic repair was performed in 2 patients with right late-presenting BDH. Laparoscopic repair was performed in 3 patients and thoracoscopic repair was performed in 2 patients in patients with left late-presenting BDH. The mean hospital stay is 7.6 days, and the mean surgery time is 131 min. When the two groups were compared, the duration of surgery and hospitalization was significantly shorter in the MIS group (p<0.05). There was no difference in both groups in terms of recurrence and complication (p>0,05).
Conclusions: The clinical characteristics of late-presenting BDH are variable, either acute or chronic. The herniated side and the affected organs have different symptoms. There is no correlation between symptoms and age. Generally, can be diagnosed with Chest X-ray, but it should be evaluated with CT or Up-Low GIS Series in differential diagnoses and in suspected cases. When the right and left late-presenting BDH hernias were compared, no significant difference was found between them. A laparoscopic or thoracoscopic approach in selected patients may be preferred.