Abdominal wall closure with a silastic patch after repair of congenital diaphragmatic hernia
Shlomo Kyzer1, Lea Sirota, Chaim Chaimoff
1Department of Surgery B, Wolfson Medical Center, Holon, Israel.
Insights
A novel surgical technique using a Silastic patch for congenital diaphragmatic hernia (CDH) closure resulted in a high survival rate. This method offers a tension-free abdominal wall closure, improving outcomes for newborns with CDH.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Thoracic Surgery
Background:
- Congenital diaphragmatic hernia (CDH) presents a significant mortality risk (50-70%) in newborns.
- Tensioned closure of the abdominal cavity in CDH patients is associated with detrimental outcomes.
Purpose of the Study:
- To evaluate a novel surgical technique for tension-free abdominal wall closure in high-risk newborns with CDH.
- To assess the efficacy and safety of using a Silastic patch for CDH repair.
Main Methods:
- Twelve high-risk newborns with CDH underwent surgical repair utilizing a Silastic patch for abdominal wall closure.
- The Silastic patch was sutured to the fascia with absorbable sutures, left open to the air, and lubricated with gentamicin sulfate ointment.
- Skin closure was deferred, allowing for gradual abdominal wall closure.
Main Results:
- A high survival rate of 91.6% (11 out of 12 patients) was achieved.
- No instances of local or systemic septic complications were reported.
- Gradual abdominal wall closure was successful, with complete closure achieved in an average of 4.9 weeks.
Conclusions:
- The Silastic patch technique facilitates tension-free abdominal wall closure in CDH repair.
- This method demonstrates a high survival rate and complication-free healing, making it suitable for challenging CDH cases.
- The technique offers a viable alternative when other methods for tension-free closure are not feasible.
Hypothesis:
Newborns with congenital diaphragmatic hernia (CDH) have a high risk of mortality, ranging from 50% to 70%. Tensioned closure of the narrowed abdominal cavity is detrimental.
Patients And Methods:
Twelve high-risk newborns underwent operation for CDH. To achieve tension-free closure of the abdominal wall, a Silastic patch was used. The Silastic patch was sutured intermittently to the edges of the abdominal wall fascia with absorbable sutures and left open to the air. The skin was not closed above the Silastic patch, which was lubricated with 1% gentamicin sulfate ointment.
Results:
Eleven patients (91.6%) survived. No local or systemic septic complication occurred. The abdominal wall was gradually closed, and total closure was achieved within 4 to 6 weeks (mean, 4.9 weeks).
Conclusion:
Because of the high survival rate and the complication-free rapid healing of the abdominal wall, the technique can be used in any case of CHD in which tension-free closure of the abdominal wall cannot be achieved by other methods.
