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[Reconstruction of the diaphragm with a polytetrafluoroethylene patch in neonates with congenital diaphragmatic
1Klinika dĕtské chirurgie 2. LF UK a FN Motol, Subkatedra dĕtské chirurgie IPVZ, Praha. mrygl@yahoo.com
Insights
This study evaluated polytetrafluoroethylene (PTFE) patches for congenital diaphragmatic hernia repair in 66 neonates. PTFE patches are suitable for major defects, but long-term effects require further investigation.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Neonatal Medicine
Context:
- Congenital diaphragmatic hernia (CDH) is a severe condition requiring surgical intervention in neonates.
- Diaphragmatic reconstruction is crucial for respiratory function and survival.
- Synthetic materials like polytetrafluoroethylene (PTFE) patches are used for large diaphragmatic defects.
Purpose:
- To assess the efficacy and outcomes of diaphragmatic reconstruction using PTFE patches in neonates with CDH.
- To compare outcomes between simple diaphragm reconstruction and reconstruction with PTFE patches.
- To identify indications and potential complications associated with PTFE patch use in CDH repair.
Summary:
- A cohort of 66 neonates with CDH underwent diaphragmatic reconstruction; 14 (26%) received PTFE patches.
- Nine patients (64%) treated with PTFE patches recovered without complications; one relapse occurred in a complex case.
- Overall mortality was 27%, with five deaths post-surgery, four of which involved PTFE patches, often with severe complications.
Impact:
- PTFE patch reconstruction is a viable surgical option for neonates with CDH, particularly for agenesis or major defects.
- The long-term effects of non-absorbable synthetic patches on skeletal growth and deformities remain uncertain.
- Further research is needed to fully understand the long-term implications of PTFE patch use in pediatric diaphragmatic reconstruction.
Abstract:
The authors present their experience with the reconstruction of the diaphragm with a synthetic polytetrafluoroethylene patch in a group of 66 neonates with a congenital diaphragmatic hernia. After preoperative stabilization 53 neonates (80%) were operated, simple reconstruction of the diaphragm was made in 39 neonates (74%), reconstruction of the diaphragm with a polytetrafluoroethylene patch was indicated in 14 patients (26%). Nine patients recovered after reconstruction of the diaphragm by a synthetic patch without complications. The only relapse of diaphragmatic hernia when using a patch was recorded in a neonate with a bilateral diaphragmatic hernia, sternal cleft and omphalocele. After simple reconstruction of the diaphragm there was no relapse of hernia. The total mortality in the group was 27% (18 neonates). After surgery five neonates died. Two of them died of serious haemorrhagic complications during extracorporeal membrane oxygenation and three died after operations performed at borderline oxygenation and ventilation values and subsequent deterioration of the general condition. In four of them a polytetrafluoroethylene patch (GORE-TEX) was used. Reconstruction of the diaphragm by a polytetrafluoroethylene patch is a suitable surgical method in the treatment of neonates with a congenital diaphragmatic hernia. Indication for the use of a patch is agenesis of the diaphragm and major diaphragmatic defects with hypoplastic borders. The use of a non-absorbable synthetic patch is from the aspect of the long-term effect on growth and the development of skeletal deformities equivocal and will call for further detailed studies.
