Original articlePatch repair for congenital diaphragmatic hernia: is it really a problem?
Section snippets
Materials and methods
After approval of the study by the Children's Hospital of Philadelphia (CHOP) Institutional Review Board (IRB no. 10-007917), a retrospective search of the databases of both the CHOP Center for Fetal Diagnosis and Treatment and Pulmonary Hypoplasia Program was performed for patients with a diagnosis of CDH who underwent initial surgery at CHOP between January 1, 1999, and October 30, 2010. Patients who were diagnosed with CDH but did not undergo repair, had a repair performed at a different
Results
We identified 184 consecutive patients with CDH who underwent surgical repair at CHOP of whom 149 (81%) patients survived to discharge and became the study cohort. Ninety-nine (53.8%) of the 184 patients required prosthetic patch repair and 85 (46.2%) underwent primary repair. Twenty-five patch repair patients and 4 primary repair patients did not survive to discharge; 6 patients with primary repair had no documented follow-up. Of the 149 survivors with follow-up, 75 (50.3%) were repaired
Discussion
Advances in neonatal management have led to improved survival of patients with severe CDH and their associated large diaphragmatic defects. Diaphragmatic defects too large for primary repair are most commonly closed using a synthetic patch although the surgical technique used for patch repair varies widely. The literature is replete with studies citing a very high recurrence rate for synthetic patch repairs (Table 2) ranging from 14% to 50% [3], [4], [5], [6], [7], [8], [9], [10]. In addition,
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2022, Surgical Clinics of North AmericaCitation Excerpt :For large CDH defects, a prosthetic patch, typically polytetrafluoroethylene (Gore-Tex Soft Tissue Patch, Flagstaff, AZ), may be needed for the diaphragm repair or to supplement or reinforce a repair that can only be partially approximated primarily without tension. Mesh repairs have historically been associated with higher rates of postoperative adhesive bowel obstructions and recurrences; however, some recent studies have not found a significant increase in the risk of recurrence with patch repair.35–38 Many have abandoned using biologic mesh alone due to high rates of recurrence.37,39
Does creating a dome reduce recurrence in congenital diaphragmatic hernia following patch repair?
2022, Journal of Pediatric SurgeryCitation Excerpt :Hernia recurrence is a common morbidity that has been linked to both the size of defect and type of repair including a minimally invasive approach [4,5]. Large defect sizes such as types C and D are commonly repaired with a patch to achieve adequate closure, however, compared to primary repair, patch repair has been associated with a higher rate of CDH recurrence, from 14 to 50% [6–14]. It has been hypothesized that the recurrence rate in patch repair can be minimized with optimal surgical technique [14].
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These authors contributed equally to this work.