Recurrence of anterior congenital diaphragmatic hernia after laparoscopic repair in children
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In brief
In brief
This study examines laparoscopic repair outcomes for anterior congenital diaphragmatic hernia in children, identifying Down syndrome and absorbable suture use as significant risk factors for recurrence. Meta-analysis of 156 cases shows recurrence rates of 19.4% in Down syndrome patients versus 2.5% in others, suggesting non-absorbable sutures and prosthetic patches may be warranted in high-risk cases.
- Laparoscopic repair of anterior CDH without patch is safe and effective using extracorporeal subcutaneous knot tying technique.
- Recurrence risk is significantly higher in patients with Down syndrome (19.4%) compared to those without (2.5%).
- Non-absorbable sutures reduce recurrence rates (5.3%) compared to absorbable sutures (50%) in anterior CDH repair.
- Consider prosthetic patch for tension-free closure in Down syndrome patients or those with prior cardiac surgery history.
- Primary suture repair without patch achieved low recurrence in appropriately selected pediatric anterior CDH cases.
Written by the GCMD Library team from the article.
Abstract
Purpose
To report our experience with laparoscopic repair of anterior congenital diaphragmatic hernia (CDH) using extracorporeal subcutaneous knot tying and to define recurrence risk factors.
Methods
This retrospective unicentric study included children who underwent laparoscopic repair of anterior CDH without patch, using extracorporeal knot tying of sutures passed through the full thickness of the abdominal wall (2013–2020). A systematic review of the literature with meta-analysis was performed using the MEDLINE database since 2000.
Results
Eight children were included (12 months [1–183]; 10.6 kg [3.6–65]). Among the two patients with Down syndrome, one with previous cardiac surgery had a recurrence at 17 months postoperatively. In our systematic review (26 articles), among the 156 patients included, 10 had a recurrence (none with patch). Recurrence was statistically more frequent in patients with Down syndrome (19.4%) than without (2.5%) (p < 0.0001), and when absorbable sutures were used (50%) instead of non-absorbable sutures (5.3%) (p < 0.0001).
Conclusion
Laparoscopic repair of anterior CDH without patch was a safe and efficient surgical approach in our patients. The use of a non-absorbable prosthetic patch should be specifically discussed in anterior CDH associated with Down syndrome and/or in case of previous cardiac surgery to perform a diaphragmatic tension-free closure.