Outcome of Congenital Diaphragmatic Hernia Repair Depending on Patch Type

Abstract

Introduction: Patch repair of a congenital diaphragmatic hernia is associated with a much higher rate of recurrence than when primary repair is feasible. The biosynthetic options for the repair materials continue to expand. We therefore reviewed our experience to benchmark complication rates as we progress with the use of new materials.

Methods: A retrospective review was conducted of all patients who underwent repair of congenital diaphragmatic hernia from January 1994 to May 2009.

Results: Of the 155 patients included in the study, 101 patients had primary closure and 54 received a diaphragmatic patch. The rates of recurrence, Small Bowel Obstruction (SBO), and subsequent abdominal operation were all significantly higher in the group of patients requiring patch repair. There were 3 types of patch repairs: 37 patients received a SIS patch, 12 had a nonabsorbable patch, and 5 received an AlloDerm patch. The incidence of SBO in patients with a nonabsorbable mesh was 17% and was associated with a 50% recurrence rate and 67% re-recurrence rate. SIS was associated with 19% incidence of SBO, a recurrence rate of 22% and a 50% re-recurrence rate, whereas AlloDerm had a 40% incidence of SBO, 40% recurrence rate, and 100% re-recurrence rate.

Discussion: As we move towards the next generation of materials, these data do not justify the continued comparison with nonabsorbable patches. We do not have enough comparative data to define a superior biosynthetic material, but we plan to use our data on SIS to benchmark our experience with future generation materials.

Key words

congenital diaphragmatic hernia - patch - recurrence - obstruction

References

• 1 St Peter SD, Valusek PA, Tsao J. et al . Abdominal complications related to type of repair for congenital diaphragmatic hernia.  J Surg Research. 2007;  140 234-236
• 2 Lund DP, Mitchell J, Kharasch V. et al . Congenital diaphragmatic hernia: The hidden morbidity.  J Pediatr Surg. 1994;  29 (2) 258-264
• 3 Grethel EJ, Cortes RA, Wagner AJ. et al . Prosthetic patches for congenital diaphragmatic hernia repair: Surgisis vs Gore-Tex.  J Pediatr Surg. 2006;  41 (1) 29-33
• 4 Menon NG, Rodriguez ED, Byrnes CK. et al . Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model.  Ann Plast Surg. 2003;  50 523-527
• 5 Silverman RP, Li EN, Holton III LH. et al . Ventral hernia repair using allogenic acellular dermal matrix in a swine model.  Hernia. 2004;  8 (4) 336-342
• 6 Butler CE, Prieto VG. Reduction of adhesions with composite AlloDerm/polypropylene mesh implants for abdominal wall reconstruction.  Plast Reconstr Surg. 2004;  114 (2) 464-473
• 7 Mitchell IC, Garcia NM, Barber R. et al . Permacol: a potential biologic patch alternative in congenital diaphragmatic hernia repair.  J Pediatr Surg. 2008;  43 (12) 2161-2164
• 8 Moss RL, Chen CM, Harrison MR. Prosthetic patch durability in congenital diaphragmatic hernia: a long-term follow-up study.  J Pediatr Surg. 2001;  36 (1) 152-154
• 9 Riehle KJ, Magnuson DK, Waldhausen JH. Low recurrence rate after Gore-Tex/Marlex composite patch repair for posterolateral congenital diaphragmatic hernia.  J Pediatr Surg. 2007;  42 (11) 1841-1844

Correspondence