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Outcomes following prosthetic patch repair in newborns with congenital diaphragmatic hernia
W B Jawaid1, E Qasem, M O Jones
1Academic Paediatric Surgery Unit, Division of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
Insights
Congenital diaphragmatic hernia (CDH) repair using prosthetic patches has a low recurrence rate of 5%. Abdominal wall patching in CDH newborns indicates higher mortality risk, highlighting the need for prenatal assessment.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Medical Device Technology
Background:
- Congenital diaphragmatic hernia (CDH) often requires prosthetic patch repair for diaphragmatic defects.
- High rates of patch failure and recurrence (up to 50%) have been historically reported.
- This study assesses current outcomes of prosthetic patch repair for CDH at a UK center.
Purpose of the Study:
- To evaluate contemporary outcomes of prosthetic patch repair in newborns with CDH.
- To analyze the types of patches used and their association with recurrence and survival.
- To identify predictors of mortality in CDH patients requiring patch repair.
Main Methods:
- Retrospective review of medical records for newborns undergoing CDH surgery (1990-2010).
- Analysis of operative details, patch utilization (Gore-Tex®, Surgisis®), and follow-up data.
- Comparison of outcomes between primary repair, diaphragmatic patch repair, and abdominal wall patch repair.
Main Results:
- Of 118 CDH infants, 37 required diaphragmatic patches (35 Gore-Tex®, 2 Surgisis®).
- Overall survival was 86.4% (102/118). Early recurrences (2) were linked to biological patches.
- Abdominal wall patching, with or without diaphragmatic patching, significantly increased mortality (40% vs 9.7%).
Conclusions:
- Prosthetic diaphragmatic hernia repair demonstrated a favorable outcome with a 5% recurrence rate in this cohort.
- Inadequate abdominal domain identified prenatally may predict increased mortality in CDH newborns.
- Gore-Tex® patches showed good results, while biological patches were associated with early recurrence.
Background:
The anatomical defect in congenital diaphragmatic hernia (CDH) can usually be closed primarily but prosthetic patch repair may be required in newborns with a deficient diaphragm. High rates of patch failure and hernia recurrence (up to 50 per cent) have been reported. This study evaluated contemporary outcomes following patch repair of CDH at a UK paediatric surgical centre.
Methods:
Medical records of newborns undergoing surgery for CDH between 1 February 1990 and 1 November 2010, and attending a multidisciplinary follow-up clinic, were examined. Operative details and patch utilization are reported.
Results:
Of 118 newborns with CDH, 37 required a patch to the diaphragmatic defect. Gore-Tex® patches were used in 35 and biological Surgisis® patches in two. Eight babies additionally required an abdominal wall patch. Seven infants had an abdominal patch alone with primary diaphragm repair. A total of 102 infants (86·4 per cent) survived after surgery. Two early recurrences were both related to the use of biological patches, leading to revisional surgery with Gore-Tex® patch reconstruction. Diaphragmatic patch use was associated with a greater requirement for intensive cardiovascular and respiratory support, although there was no significant difference in mortality between patch versus primary diaphragm repair. The mortality rate was significantly higher among infants requiring abdominal wall patching (with or without a diaphragmatic patch): 40 per cent (6 of 15) versus 9·7 per cent (10 of 103) (P = 0·006). Postoperative survival rates for infants with a diaphragmatic patch alone, abdominal wall patch alone, and both abdominal and diaphragmatic patches were 86 per cent (25 of 29), 57 per cent (4 of 7) and 63 per cent (5 of 8) respectively.
Conclusion:
Prosthetic diaphragmatic hernia repair at this centre has a good outcome and low rate of recurrence (5 per cent). The recognition of an inadequate abdominal domain prenatally may additionally prove to be a useful marker for predicting increased mortality in newborns with CDH.
