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Musculoskeletal deformities following repair of large congenital diaphragmatic hernias
Katie W Russell1, Douglas C Barnhart1, Michael D Rollins1
1University of Utah, Primary Children's Hospital, Division of Pediatric Surgery, Salt Lake City, UT, USA.
Insights
Scoliosis and chest wall deformities are common after large congenital diaphragmatic hernia (CDH) repair. The surgical method, whether muscle flap or prosthetic patch, did not significantly impact the occurrence of these skeletal issues.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Abnormalities
Background:
- Large congenital diaphragmatic hernias (CDH) require surgical repair, often involving muscle flaps or prosthetic patches.
- Post-repair deformities such as scoliosis and chest wall abnormalities can impact patient outcomes.
Purpose of the Study:
- To evaluate the frequency and severity of scoliosis, chest wall, and abdominal wall deformities after CDH repair.
- To compare outcomes between muscle flap and prosthetic patch repair techniques.
Main Methods:
- Retrospective review of neonates undergoing CDH repair between 1989 and 2012.
- Validation through prospective radiologic and clinical evaluations.
- Fisher's exact test used for association analysis.
Main Results:
- Among 236 survivors, 30 had muscle flap and 13 had patch repairs.
- Pectus deformities were observed in 47% of flap and 54% of patch repairs (retrospective).
- Scoliosis occurred in 13% of flap and 15% of patch repairs (retrospective).
- Prospective data showed 75% of flap and 67% of patch patients had pectus; 13% of flap and 33% of patch patients had scoliosis.
- No significant difference in deformity incidence between repair types.
Conclusions:
- Scoliosis and pectus deformities are frequent sequelae in children with large CDH.
- The choice of surgical technique (muscle flap vs. patch) does not appear to influence the rate of subsequent skeletal deformities.
Purpose:
Large congenital diaphragmatic hernias (CDH) can be repaired with either a muscle flap or prosthetic patch. The purpose of this study was to assess the frequency and severity of scoliosis, chest wall, and abdominal wall deformities following these repairs.
Methods:
Neonates who underwent CDH repair (1989-2012) were retrospectively reviewed. We then validated our retrospective review by comparing results of a focused radiologic evaluation and clinical examination of patients with large defects seen in prospective follow-up clinic. Tests for association were made using Fisher's exact test.
Results:
236 patients survived at least 1year. Of these patients, 30 had a muscle flap, and 13 had a patch repair. Retrospectively, we identified pectus in 9% of primary repairs, 47% of flap repairs, and 54% of patch repairs. We identified scoliosis in 7% of primary repairs, 13% of flap repairs, and 15% of patch repairs. Prospectively, 75% of flap patients and 67% of patch patients had pectus and 13% of flap patients and 33% of patch patients had scoliosis. There was no significant difference between flap and patch patients.
Conclusions:
Scoliosis and pectus deformity were common in children with large CDH. The operative technique did not appear to affect the incidence of subsequent skeletal deformity.
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