title: Patch repair for congenital diaphragmatic hernia: is it really a problem?
abstract: BACKGROUND
  Large congenital diaphragmatic hernia (CDH) defects often require the use of synthetic patches for tension-free repair. Although high rates of recurrence and other morbidities have been previously reported, our favorable perception of patch repair prompted this review.
  
  
  METHODS
  A single-center retrospective chart review of CDH cases repaired between January 1, 1999, and October 1, 2010. Patch repairs were performed by multiple surgeons with an effort to construct a tension-free dome-shaped patch.
  
  
  RESULTS
  One hundred eighty-four children underwent CDH repair of whom 99 (53.8%) required a patch. Seventy-four (74.7%) of the 99 patients who underwent patch repair survived to discharge and were compared with 75 primary repair survivors. Of those undergoing patch repair, 88% were prenatally diagnosed, 55% had liver herniation, and 22 (29.9%) were repaired on extracorporeal membrane oxygenation. Two patients experienced a recurrence after a patch repair and 3 after a primary repair for a rate of 5.4% and 4.0%, respectively (P = 1.0).
  
  
  CONCLUSIONS
  These results demonstrate that synthetic patch repair for CDH can be performed with a very low rate of recurrence challenging the need for alternative approaches to diaphragmatic replacement. High rates of recurrence reported for patch repair may be technical rather than intrinsic to the patch.
authors.affiliation: The Department of Surgery, and The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Tsai
authors.forename: Jason
authors.initials: J
authors.lastname: Sulkowski
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011138:Polytetrafluoroethylene; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene