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A review of patch options in the repair of congenital diaphragm defects
Alessandra C Gasior1, Shawn D St Peter
1Department of Pediatric Surgery, The Children's Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
Insights
Repairing congenital diaphragmatic hernia (CDH) remains challenging. Current mesh options for CDH repair have limitations, and more research is needed to find the ideal material for better patient outcomes.
Area of Science:
- Pediatric Surgery
- Biomaterials Science
- Medical Engineering
Background:
- Congenital diaphragmatic hernia (CDH) repair presents ongoing challenges for pediatric surgeons.
- While delayed repair has improved mortality, significant morbidity persists, particularly with mesh use.
- Recurrence and obstruction are common complications associated with current mesh repair techniques.
Purpose of the Study:
- To review current mesh materials used in CDH repair.
- To analyze reported advantages and existing animal and clinical studies of various mesh types.
- To identify gaps in knowledge regarding the ideal mesh for CDH repair.
Main Methods:
- Literature review of non-absorbable prosthetic, absorbable biosynthetic, and composite meshes.
- Analysis of reported advantages and outcomes from animal and clinical studies.
- Assessment of comparative data availability for different mesh types.
Main Results:
- Several mesh types are available for CDH repair when primary closure is not feasible.
- Existing studies report on the advantages of various mesh materials.
- Crucially, adequate comparative data across different mesh types is lacking.
Conclusions:
- The ideal mesh for congenital diaphragmatic hernia repair remains elusive.
- Current mesh options have limitations, contributing to ongoing morbidity.
- Further animal models and clinical studies are essential to guide the selection of optimal mesh materials for CDH repair.
Abstract:
Repair of congenital diaphragmatic hernia (CDH) continues to pose a dilemma for the pediatric surgeon. While the management of CDH has evolved from surgical urgency to delayed repair after medical optimization with substantial improvements in mortality, morbidity continues to perplex clinicians. Significant morbidity occurs with recurrence, re-recurrence and complications such as obstructions, principally with mesh repair. When primary closure is not possible, mesh repair is indicated. While there are several non-absorbable prosthetic, absorbable biosynthetic and composite mesh types available, the ideal mesh remains elusive. In this article, we reviewed the current materials, reported advantages, and animal and clinical studies of non-absorbable prosthetic, absorbable biosynthetic and composite mesh. However, adequate comparative data are lacking, leaving a wide void for future animal models and clinical studies.
