Abdominal wall muscle weakness outcomes after split abdominal flap repair of large congenital diaphragmatic hernias in newborn
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In brief
In brief
This retrospective study of 18 neonates demonstrates that split abdominal wall muscle flap repair for large CDH defects results in transient abdominal wall weakness that resolves spontaneously in 94% of patients by 3 years without requiring intervention. The technique achieved low recurrence rates (5.6%) and no mortality, supporting its use despite theoretical concerns about muscle weakness.
- Split abdominal wall muscle flap (SAWMF) effectively repairs large CDH defects with only 5.6% recurrence rate in 18 neonates.
- Abdominal wall weakness post-SAWMF is asymptomatic and resolves spontaneously in 67% at 1 year, 94% by 3 years.
- SAWMF is safe for severe CDH cases (78% liver-up, mean LHR 1.49) without requiring surgical correction of muscle weakness.
- No patients required treatment for abdominal wall weakness or died, supporting SAWMF as a viable primary repair technique.
- Muscle weakness manifests as a bulge but does not limit function, making SAWMF concerns about donor-site morbidity unfounded.
Written by the GCMD Library team from the article.
Abstract
Purpose
Split abdominal wall muscle flap (SAWMF) is a technique to repair large defects in congenital diaphragmatic hernia (CDH). A possible objection to this intervention could be any associated abdominal muscle weakness. Our aim is to analyze the evolution of this abdominal muscle wall weakness.
Methods
Retrospective review of CDH repair by SAWMF (internal oblique muscle and transverse) from 2004 to 2023 focusing on the evolution of muscle wall weakness.
Results
Eighteen neonates of 148 CDH patients (12,1%) were repaired using SAWMF. Mean gestational age and birth weight were 35.7 ± 3.5 weeks and 2587 ± 816 g. Mean lung-to-head ratio was 1.49 ± 0.28 and 78% liver-up. Seven patients (38%) were prenatally treated by tracheal occlusion.
Ninety-four percent of the flaps were used for primary repair and one to repair a recurrence. One patient (5.6%) experienced recurrence.
Abdominal muscle wall weakness was present in the form of a bulge. Resolution of weakness at 1, 2 and 3 years was 67%, 89% and 94%, respectively. No patient required treatment for weakness or died.
Conclusions
Abdominal muscular weakness after a split abdominal wall muscle flap repair is not a limitation for its realization since it is asymptomatic and presents a prompt spontaneous resolution.
Level of evidence
IV.