[Congenital diaphragmatic hernia. Therapeutic re-evaluation].
Twenty-eight patients with "High-Risk" diaphragmatic hernia were treated without postoperative ipsilateral chest drains. Overall survival was 71%. This study suggests that, in cases of complete absence of the diaphragm, the use of a mesh pervious to air is as noxious postoperatively as an underwater chest drain. This idea is supported by experiments in cats with a left pneumonectomy, in which part of the diaphragm was replaced either by a macroporous mesh or by a microporous prosthesis impervious to air at normal pressures. Moreover, barotrauma may occur preoperatively and when assisted ventilation is required, inspiratory pressure must be strictly limited.
Cloutier
R
R
Service de Chirurgie Pédiatrique et d'Anesthésie, Centre Hospitalier de l'Université Laval, Sainte-Foy, Québec, Canada.
Fournier
L
L
Major
D
D
Béland
L
L
Péloquin
J
J
Poncelet
P
P
D000818:Animals; D002415:Cats; D003964:Diaphragm / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D010795:Phthalic Acids; D011013:Pneumonectomy; D011092:Polyethylene Glycols; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D011312:Pressure; D013526:Surgical Mesh; D013909:Thorax / Q000502:physiology
D010795:Phthalic Acids; D011093:Polyethylene Terephthalates; C025539:Lavsan; D011092:Polyethylene Glycols; D011138:Polytetrafluoroethylene
La hernie diaphragmatique congénitale. Réévaluation thérapeutique.