When primary repair is not enough: a comparison of synthetic patch and muscle flap closure in congenital diaphragmatic hernia?
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In brief
In brief
This retrospective study compares outcomes of synthetic patch versus autologous muscle flap repair for large congenital diaphragmatic hernias requiring more than primary closure. With 5-year median follow-up, both techniques showed similarly low reherniation rates (8.8% patch vs 3.5% flap, p=0.295), supporting either approach as durable for complex CDH repair.
Written by the GCMD Library team from the article.
Abstract
Purpose
Primary closure is often inadequate for large congenital diaphragmatic hernia (CDH) and necessitates repair by prosthetic patch or autologous muscle flap. Our aim was to evaluate outcomes of open patch versus flap repair, specifically diaphragmatic reherniation.
Methods
A retrospective review (IRB #2017-6361) was performed on all CDH patients repaired from 2005 to 2016 at a single academic children’s hospital. Patients were excluded from final analysis if they had primary or minimally invasive repair, expired, or were lost to follow-up.
Results
Of 171 patients, 151 (88.3%) survived to discharge, 9 expired after discharge and 11 were lost to follow up, leaving 131 (86.8%) long-term survivors. Median follow-up was 5 years. Open repair was performed in 119 (90.8%) of which 28 (23.5%) underwent primary repair, 34 (28.6%) patch repair, and 57 (47.9%) flap repair. Overall, 6/119 (5%) patients reherniated, 1/28 (3.6%) in the primary group, 3/34 (8.8%) in the patch group, and 2/57 (3.5%) in the flap group. Comparing prosthetic patch to muscle flap repair, there was no significant difference in the number of patients who recurred nor time to reherniation (3 vs. 2, p = 0.295; 5.5 ± 0.00 months vs. 53.75 ± 71.06 months, p = 0.288). One patient in the patch group recurred twice.
Conclusions
Both muscle flap and patch repair of large CDH are feasible and durable with a relatively low risk of recurrence.