Effectiveness of diaphragmatic repair using an abdominal muscle flap in patients with recurrent congenital diaphragmatic hernia.
OBJECTIVE
Recurrent congenital diaphragmatic hernia (Re-CDH) is a well-known complication of CDH repair. Although surgical treatment is required for Re-CDH, the question regarding which technique is the optimal treatment has not yet been elucidated. We performed a repair using an abdominal muscle flap (AMF) for Re-CDH and herein report our experience.


RESULTS
Four patients using AMF had left Re-CDH. The patient's age at operation was around 1 year old in all patients. In the first repair during the neonatal period, a Gore-Tex patch was required for the large defect in 3 patients, whereas a primary closure was selected in 1 patient because the anterior diaphragm remained as a partial remnant. In the 3 patients in whom a Gore-Tex patch was used in the first operation, recurrence occurred twice. All of the patients suffered from both pulmonary hypertension and growth retardation. A repair using AMF (the flap of both the internal oblique and the transversalis abdominal muscle) was performed in all patients. The clinical course was good in all patients, with an improvement of both pulmonary hypertension and growth retardation without any recurrence of CDH.


CONCLUSIONS
The use of an AMF was thus found to be an effective technique for repairing a large defect in Re-CDH.
Masumoto
Kouji
K
Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. kmasu@pedsurg.med.kyushu-u.ac.jp
Nagata
Kouji
K
Souzaki
Ryota
R
Uesugi
Toru
T
Takahashi
Yukiko
Y
Taguchi
Tomoaki
T
D000009:Abdominal Muscles / Q000637:transplantation*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps; D015996:Survival Rate; D013718:Tensile Strength; D016896:Treatment Outcome