Permacol: a potential biologic patch alternative in congenital diaphragmatic hernia repair.
OBJECTIVE
Recurrence is a well-known complication after patch repair of congenital diaphragmatic hernia (CDH). We propose that a newer, "bioprosthetic" material may lower recurrence rates. The purpose of this study is to compare outcomes of CDH repair with synthetic Gore-Tex (W. L. Gore and Associates, Neward, Del) to the bioprosthetic Permacol (Tissue Science Laboratories Inc, Andover, Mass).


METHODS
We performed a retrospective review of 100 consecutive patients with CDH with survival more than 30 days at Children's Medical Center of Dallas (Dallas, Tex) from 1999 to 2007. The incidence and timing of recurrence, as well as comorbidities were assessed.


RESULTS
Primary repair was performed in 63 patients and patch repair in 37, divided between Gore-Tex (29) and Permacol (8). Overall recurrences were as follows: 1 (2%), 8 (28%), and 0 in the primary, Gore-Tex, and Permacol groups, respectively. Median follow-up was 57 months for Gore-Tex and 20 months for Permacol. Median time to recurrence in the Gore-Tex group was 12 months, with no Permacol recurrences. Both the Gore-Tex and Permacol groups had similar comorbidities, including prematurity, congenital heart disease (76% and 63%, respectively), and the need for extracorporeal membrane oxygenation support (38% and 25%).


CONCLUSIONS
Our results suggest that Permacol may have lower recurrence rates compared to Gore-Tex and is a promising alternative biologic graft for CDH repair.
Mitchell
Ian C
IC
Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Garcia
Nilda M
NM
Barber
Robert
R
Ahmad
Naveed
N
Hicks
Barry A
BA
Fischer
Anne C
AC
D000015:Abnormalities, Multiple; D000818:Animals; D001672:Biocompatible Materials; D002675:Child, Preschool; D003094:Collagen / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D011138:Polytetrafluoroethylene; D019736:Prostheses and Implants; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D001672:Biocompatible Materials; C422414:Permacol; D011138:Polytetrafluoroethylene; D003094:Collagen