How is congenital diaphragmatic hernia treated?
Fetal open surgery for CDH has shifted to postnatal procedures after stabilization of the neonate. Though open fetal surgery was initially utilized, survival rates were low. Advances in the care of neonates with CDH meant that the survival rate of neonates with CDH was higher than the survival rate of fetuses treated with open fetal surgery. While most CDH fetuses are now treated as neonates, a procedure less invasive than open surgery is being evaluated. It involves the reversible occlusion of the fetal trachea, intentionally creating a CHAOS-like situation. The expanding lungs exert pressure on the herniated abdominal contents. This can push the herniated contents at least partway back into the abdomen. The tracheal occlusion is then reversed so an airway can be established. This procedure is known as fetoscopic tracheal occlusion (FETO). Though FETO is attractive and has some successes, improvements in survival of affected neonates using improved respirators and techniques has also meant that this method may not be superior to postnatal management.