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Salvaging the severe congenital diaphragmatic hernia patient: is a silo the solution?
Ankur R Rana1, Joseph S Khouri, Daniel H Teitelbaum
1Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA.
Insights
Abdominal wall silo placement improved survival in infants with congenital diaphragmatic hernia (CDH) needing ECMO. This technique effectively managed decreased abdominal domain, leading to 100% survival in this high-risk group.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Thoracic Surgery
Background:
- Severe congenital diaphragmatic hernia (CDH) in infants requiring extracorporeal membrane oxygenation (ECMO) is associated with high morbidity and mortality.
- Decreased abdominal domain is a significant challenge in managing these infants.
Purpose of the Study:
- To evaluate the efficacy of abdominal wall silo placement and staged closure in infants with CDH requiring ECMO.
- To assess the impact of this strategy on survival and associated complications.
Main Methods:
- Retrospective review of 7 infants with CDH requiring ECMO treated with a silastic abdominal wall silo between 2003 and 2006.
- Analysis of survival rates, ECMO duration, silo duration, time to discharge, and long-term outcomes.
Main Results:
- All 7 patients (100%) survived, exceeding the predicted survival rate of 47%.
- ECMO duration averaged 15 days. Abdominal wall closure occurred at a mean of 21 days.
- Hospital stay averaged 54 days with no reported infections or wound complications.
Conclusions:
- Abdominal wall silo placement is an effective strategy for managing decreased abdominal domain in infants with CDH requiring ECMO.
- This approach appears to improve survival outcomes in this high-risk population.
- Further research is needed to confirm the efficacy of this intervention.
Background:
Infants with severe congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) have a high morbidity and mortality. We hypothesized that placement of an abdominal wall silo and staged abdominal wall closure may reduce problems associated with decreased abdominal domain in CDH.
Methods:
We performed a retrospective review and identified 7 CDH patients requiring ECMO who had a silastic abdominal wall silo between 2003 and 2006. Variables analyzed included survival, ECMO duration, duration of silo, time to discharge, and long-term outcome.
Results:
Predicted mean survival for the entire cohort using the published CDH Study Group equation was 47% (range, 9%-86%). All 7 patients (100%) survived. Extracorporeal membrane oxygenation duration averaged 15 days (range, 5-19 days). Four of the patients (58%) were repaired with a silo on ECMO, and 3 (42%) had their repair after ECMO. The abdominal wall defect was closed at a mean of 21 days (range, 4-41 days). Hospital stay after silo placement averaged 54 days (range, 20-170 days) with no infections or wound complications.
Conclusions:
Abdominal wall silo placement in infants with CDH requiring ECMO appears to be an effective strategy for decreased abdominal domain. Further studies are warranted to determine the efficacy of such a strategy for these high-risk CDH patients.
