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Patch repair for congenital diaphragmatic hernia: is it really a problem?
Jacqueline Tsai1, Jason Sulkowski, N Scott Adzick
1The Department of Surgery, and The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Journal of Pediatric Surgery
|April 14, 2012
Summary
Synthetic patch repair for congenital diaphragmatic hernia (CDH) shows a low recurrence rate. This challenges the need for alternative diaphragmatic replacement methods, suggesting technical factors influence recurrence, not the patch itself.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Neonatal Care
Background:
- Congenital diaphragmatic hernia (CDH) often necessitates synthetic patch use for large defects.
- Previous reports indicated high recurrence and morbidity with patch repair.
- This study reviewed patch repair outcomes due to a positive institutional perception.
Purpose of the Study:
- To evaluate the recurrence rate and outcomes of synthetic patch repair in congenital diaphragmatic hernia (CDH).
- To compare patch repair outcomes with primary repair in CDH cases.
- To challenge the notion that patch repair inherently leads to high recurrence rates.
Main Methods:
- Retrospective chart review of 184 CDH cases repaired between 1999 and 2010.
- Analysis focused on 99 patients who underwent synthetic patch repair.
- Comparison of recurrence rates between patch repair and primary repair groups.
Main Results:
- 99 of 184 patients (53.8%) required patch repair for CDH.
- The recurrence rate after patch repair was 5.4% (2/37), compared to 4.0% (3/75) after primary repair (P=1.0).
- Patients undergoing patch repair had high rates of prenatal diagnosis (88%) and liver herniation (55%).
Conclusions:
- Synthetic patch repair for CDH can achieve a very low recurrence rate.
- The findings question the necessity of alternative diaphragmatic replacement techniques.
- Recurrence rates may be linked to surgical technique rather than the synthetic patch material itself.
