[Congenital diaphragmatic hernia. Therapeutic re-evaluation]

Area of Science:

• Thoracic Surgery
• Surgical Innovation
• Diaphragmatic Hernia Repair

Background:

• Diaphragmatic hernia (DH) poses significant surgical challenges, particularly in high-risk cases.
• Postoperative management often includes chest drains, but their necessity in specific DH scenarios is debated.
• Absence of the diaphragm necessitates reconstructive techniques, influencing postoperative complications.

Purpose of the Study:

• To evaluate the outcomes of high-risk diaphragmatic hernia repair without postoperative ipsilateral chest drains.
• To investigate the impact of mesh permeability on postoperative complications in cases of complete diaphragm absence.
• To assess the risk of barotrauma in diaphragmatic hernia patients requiring mechanical ventilation.

Main Methods:

• Retrospective analysis of 28 high-risk diaphragmatic hernia patients treated without postoperative ipsilateral chest drains.
• Experimental study in cats involving left pneumonectomy and diaphragmatic reconstruction with macroporous (air-permeable) or microporous (air-impermeable) prostheses.
• Evaluation of postoperative survival rates and complications.

Main Results:

• Overall survival rate of 71% was observed in the patient cohort.
• Experimental findings suggest that air-permeable meshes are as detrimental as underwater chest drains in cases of complete diaphragm absence.
• Barotrauma is identified as a potential preoperative and intraoperative risk, especially with assisted ventilation.

Conclusions:

• High-risk diaphragmatic hernia patients may be managed without ipsilateral chest drains, achieving a 71% survival rate.
• Air-permeable meshes used for diaphragmatic reconstruction in complete absence are associated with significant postoperative risks, similar to chest drains.
• Strict limitation of inspiratory pressure during assisted ventilation is crucial to prevent barotrauma in diaphragmatic hernia patients.