What is the best prosthetic material for patch repair of congenital diaphragmatic hernia? Comparison and meta-analysis of porcine small intestinal submucosa and polytetrafluoroethylene.
BACKGROUND
Prosthetic patches are widely used for congenital diaphragmatic hernia (CDH) repair. We compared the complication rate of absorbable (Surgisis [SIS]; Cook Biotech, Inc, West Lafayette, IN) and nonabsorbable (polytetrafluoroethylene [PTFE]) materials for this purpose.


METHODS
This is a retrospective review of all neonates with CDH undergoing patch closure at our institution over 10 years. Meta-analysis was also performed combining our data with the published literature examining the effect of patch type on recurrence and small bowel obstruction (SBO).


RESULTS
Primary patch (13 SIS, 9 PTFE) repair was performed in 22 (26%) of 84 patients with CDH. Groups were comparable in terms of demographics, hospital stay, ventilator days, need for high frequency oscillation, age at surgery, and length of follow-up. Likewise, recurrence rate (SIS, 4 [31%]; PTFE, 3 [33%]; P, nonsignificant [NS]), incidence of postoperative SBO (SIS, 1 [7%] vs PTFE, 2 [22%]; P, NS), and mortality (SIS, 2 [15%] and PTFE, 2 [22%]; P, NS) were similar. Meta-analysis failed to find a significant difference between SIS and PTFE both for recurrence rate (odds ratio, 1.21 [0.51-2.84]; P, NS) and SBO (odds ratio, 1.47 [0.44-4.96]; P, NS).


CONCLUSIONS
There was no difference in the incidence of CDH recurrence, SBO, or mortality post-CDH patch repair using either SIS or PTFE in our series. Meta-analysis failed to show any difference in recurrence and SBO rates between the 2 materials.
Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Rodrigo L P
RL
Romao
Ahmed
A
Nasr
Priscilla P L
PP
Chiu
Jacob C
JC
Langer
D000818:Animals; D001705:Bioprosthesis; D005260:Female; D005549:Foreign-Body Reaction / Q000453:epidemiology / Q000209:etiology; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000517:prevention & control; D007421:Intestine, Small; D008297:Male; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013909:Thorax / Q000254:growth & development; D016896:Treatment Outcome; D014945:Wound Healing
D011138:Polytetrafluoroethylene