The split abdominal wall muscle flap--a simple, mesh-free approach to repair large diaphragmatic hernia

The authors present a technique to repair large diaphragmatic hernias that is simple, can be done primarily, and offers a durable closure with living tissue.

A review of congenital diaphragmatic hernias was performed for the period between January 1991 and August 2000. Repair types included primary repair, synthetic patch, or a split abdominal wall muscle flap. The split abdominal wall muscle flap is performed by downward rotation of the internal oblique and transversalis abdominal wall muscles. This repair requires that the initial subcostal incision be positioned at least 4 to 5 cm below the costal margin, low enough to insure an adequate length of muscle will be available to fill the defect.

Eight of 158 children with congenital diaphragmatic hernia underwent repair by abdominal wall muscle flap. Five of 8 had complete agenesis. Five survived the newborn period. Of the survivors, 4 of 5 required an additional surgical procedure, but none have had a recurrent hernia.

The split abdominal wall muscle flap is an effective technique to close large diaphragmatic hernias. The repair was carried out successfully in 8 patients with massive defects. In the surviving patients, the repair has proven to be a durable restoration of the diaphragm.