Low recurrence rate after Gore-Tex/Marlex composite patch repair for posterolateral congenital diaphragmatic hernia.
OBJECTIVE
Many different prosthetic materials have been used for repair of large posterolateral congenital diaphragmatic hernias (CDH), with high recurrence rates for hernias that cannot be primarily repaired. Since 1993, we have used a composite patch of Gore-Tex/Marlex to repair large CDHs and hypothesized that this repair leads to fewer recurrences.


METHODS
This is a retrospective review of 137 consecutive patients with CDH cared for at a single institution from 1993 to 2004. Data collected include timing and method of repair and use of extracorporeal membrane oxygenation. Outcomes include hernia recurrence, complications, and death.


RESULTS
One hundred thirty-seven patients with CDH were analyzed. Repair was not attempted in 12 because of disease severity. Primary repair was accomplished in 79 and 46 required patch repair. Of the 46 patients with patch repairs, 32 required extracorporeal membrane oxygenation, and 18 died before discharge. Of the 28 patch repair survivors, 1 (3.57%) developed a recurrence over a median follow-up of 47 months (range, 2-115 months). Overall survival was 77%.


CONCLUSIONS
Gore-Tex/Marlex composite patch repair of large CDHs in this complex patient population results in a lower recurrence rate than has been reported for other types of prosthetic diaphragm repair.
Riehle
Kimberly J
KJ
Department of Surgery, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA.
Magnuson
David K
DK
Waldhausen
John H T
JH
D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods; D008297:Male; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D019919:Prosthesis Implantation / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D015996:Survival Rate; D013718:Tensile Strength; D016896:Treatment Outcome
D011126:Polypropylenes; D011138:Polytetrafluoroethylene