Recurrence following congenital diaphragmatic hernia repair: a twelve-year single-center review

Recurrence following congenital diaphragmatic hernia (CDH) repair remains an important source of morbidity. In 2021, our institution transitioned from patch to muscle flap repair for larger defects. We aimed to evaluate recurrence rates by repair type over an extended follow-up period.

ology: We performed a single-center retrospective cohort study of patients with CDH born between January 2013 and March 2025 who underwent repair at our institution. Demographic, operative, and follow-up data were abstracted from the electronic health record. Repair type was classified as primary, patch, or muscle flap. The primary outcome was recurrence. Multivariable logistic regression adjusted for age at repair, defect size, observed-to-expected lung-to-head ratio, and extracorporeal membrane oxygenation use.

Of 554 patients born with CDH during the study period, 489 underwent surgical repair: 200 primary, 197 patch, and 92 muscle flap repairs. Overall recurrence occurred in 34 patients (7.0%): 3.5% after primary repair, 11.2% after patch repair, and 5.4% after muscle flap repair. Compared with the patch cohort, the muscle flap group had shorter follow-up (2.50 ± 1.47 vs 5.46 ± 2.87 years, p<0.001) and more D-type defects (19.6% vs 7.6%, p=0.005). Difference in recurrence between patch and muscle flap repair did not reach statistical significance (p=0.134). Multivariable analysis identified no independent predictor of recurrence.

Recurrence after CDH repair was uncommon overall and lowest after primary repair. Muscle flap and patch repairs had similar recurrence rates, though muscle flap recurrences were more often amenable to primary re-repair. Longer follow-up may allow for more definitive comparisons.