Outcomes after muscle flap vs prosthetic patch repair for large congenital diaphragmatic hernias.
BACKGROUND
Repair of large congenital diaphragmatic hernia (CDH) defects still pose a significant challenge, as the defects cannot be repaired primarily. Two techniques have been widely used: autologous anterior abdominal wall muscle flap and prosthetic patch. The latter has been used more often. Our goal was to compare the short-term and long-term outcomes of these 2 approaches.


METHODS
This is a retrospective review of all neonates undergoing CDH repair at our institution from 1969 to 2006.


RESULTS
Of 188 children undergoing surgery for CDH, primary repair could not be accomplished in 51 infants (27%). Nineteen had muscle flap repair, and 32 had prosthetic patch repair (Gore-Tex [W.L. Gore and Associates, Flagstaff, AZ], n = 15; Marlex [Bard Inc, Cranston, NJ], n = 9; Surgisis [Cook, Bloomington, IN], n = 5; SILASTIC [Dow Corning, Midland, MI], n = 3). There was no significant difference in gestational age or birth weight between groups. Three patients developed an abdominal wall defect at the muscle flap donor site, but none required surgical intervention. Chest wall deformities were found in 9 patients, 3 after a muscle flap and 6 after a prosthetic patch (P = .7). Postoperative bowel obstruction occurred in 3 muscle flap patients and 1 patch patient (P = .2). There were 10 recurrences among survivors: 2 after a muscle flap and 8 after a prosthetic patch (P = .3) There were 2 deaths among the muscle flap patients (10%), and 3 deaths among the prosthetic patch repair patients (9%) (P = .1). Results were confirmed after controlling for age and comorbidities between both groups in a multivariate logistic regression.


CONCLUSIONS
These results suggest that autologous anterior abdominal wall muscle flap and prosthetic patch repairs provide similar short-term and long-term outcomes.
Nasr
Ahmed
A
The Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.
Struijs
Marie-Chantal
MC
Ein
Sigmund H
SH
Langer
Jacob C
JC
Chiu
Priscilla P L
PP
D000009:Abdominal Muscles / Q000637:transplantation; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000209:etiology; D008137:Longitudinal Studies; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography
D011138:Polytetrafluoroethylene