Recurrent congenital diaphragmatic hernia: A novel repair.
OBJECTIVE
Repair of recurrent diaphragmatic hernia continues to be a difficult problem. An innovative method using a nonabsorbable polypropylene prosthetic mesh plug placed via the thoracic approach using minimal dissection is presented.


METHODS
A retrospective analysis showed 39 children with congenital diaphragmatic hernia (CDH) who underwent repair between January 1997 and March 2000. Five children suffered a recurrence and underwent repair via the thoracic approach using the Bard Marlex Mesh Perfix Plug (C.R. Bard Inc, Billerica, MA). Follow-up was available in all children and ranged from 1 to 33 months (average, 13.8 months).


RESULTS
Age at recurrence ranged from 2 to 48 months (average, 14.8 months), and the average time between initial repair and recurrence was 8.2 months (range, 2 to 16 months). There were no recurrences after the transthoracic mesh plug diaphragmatic hernioplasty. One child died of multiple congenital anomalies 6 months after repair.


CONCLUSIONS
The transthoracic repair of recurrent diaphragmatic hernias using a nonabsorbable polypropylene prosthetic mesh plug represents an innovative approach to a difficult problem in which 5 repairs have been accomplished without recurrence in nearly 14 months of follow-up. J Pediatr Surg 36:1768-1769.
Saltzman
D A
DA
Department of Pediatric Surgery, University of Minnesota Hospital and Clinics, Minneapolis, MN 55455, USA.
Ennis
J S
JS
Mehall
J R
JR
Jackson
R J
RJ
Smith
S D
SD
Wagner
C W
CW
D002675:Child, Preschool; D003964:Diaphragm / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D011126:Polypropylenes / Q000627:therapeutic use; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013526:Surgical Mesh; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome
D011126:Polypropylenes