Postoperative Flank Bulge in Infants After Open CDH Repair: An Underreported Complication

Area of Science:

• Pediatric Surgery
• Surgical Complications
• Abdominal Wall Reconstruction

Background:

• Flank bulge (FB) is a rare postoperative complication, often following surgeries with retroperitoneal access.
• The presumed cause is iatrogenic injury to intercostal nerves T11/T12.
• Congenital diaphragmatic hernia (CDH) repair involves dissection and sutures at this thoracic level, posing a potential risk for FB.

Purpose of the Study:

• To assess the risk of flank bulge (FB) in infants following congenital diaphragmatic hernia (CDH) repair.
• To identify surgical variables associated with FB development after CDH repair.
• To evaluate the incidence and characteristics of FB in a consecutive series of CDH patients.

Main Methods:

• Retrospective analysis of patient charts from 2007-2024 with ≥3 months follow-up.
• Diagnosis of FB based on clinical examination, defined as abdominal wall protrusion without sonographic evidence of hernia.
• Statistical analysis included Pearson's and Student's t-tests, and multivariate logistic regression to identify risk factors.

Main Results:

• Out of 67 infants undergoing CDH repair, 11% developed postoperative flank bulge (FB).
• FB exclusively occurred after open repair with patch and was significantly associated with rib sutures and higher birth weight.
• One-third of FB cases resolved spontaneously; the remainder persisted without functional impairment.

Conclusions:

• Flank bulge may be an underestimated complication after open CDH repair.
• Routine assessment of abdominal wall tone is recommended during follow-up after CDH repair.
• Further research is needed to clarify the clinical impact, patient disability, and long-term sequelae of FB.