title: Abdominal wall closure in neonates after congenital diaphragmatic hernia repair.
abstract: OBJECTIVE
  Repair of Congenital Diaphragmatic Hernia (CDH) abruptly increases intra-abdominal pressure. This study sought to characterize the incidence and significance of ACS and delayed fascial closure (DFC) after CDH repair.
  
  
  METHODS
  We reviewed the CAPSNet database from 2006 to 2011, identifying the subset of patients that developed ACS or required DFC. Prenatal and demographic information, operative and physiologic details, and outcomes were investigated.
  
  
  RESULTS
  Of 349 patients with CDH, 3 (0.8%) were diagnosed with ACS, while 43 patients (12%) had DFC at the time of CDH repair. Patients more often had right-sided defects (26% vs 13%, p=0.04) and trended toward requiring a patch repair (41% vs 31.2%, p=0.23) and having a liver lobe above the diaphragmatic rim (47% vs 32.7, p=0.09). Patients with ACS or DFC had increased length of stay (47.5 vs 33.9, p=0.01), days fasting (8.2 vs 5.8, p=0.01), days on parenteral nutrition (23.6 vs 15.5, p=0.003), and days on mechanical ventilation (16.3 vs 9.0, p=0.001).
  
  
  CONCLUSIONS
  While ACS in neonates after CDH repair is rare (<1%), DFC is required relatively commonly (>10%) and is associated with right-sided diaphragmatic hernias. Inability to close abdominal fascia is associated with increased morbidity. Clinicians caring for neonates with CDH should be facile with strategies to manage delayed abdominal fascia closure.
authors.affiliation: West Virginia University Charleston Area Medical Center, WV, USA.
authors.forename: Damian
authors.initials: D
authors.lastname: Maxwell
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.forename: Pramod
authors.initials: P
authors.lastname: Puligandla
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000071938:Fasciotomy; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D059325:Intra-Abdominal Hypertension / Q000209:etiology / Q000517:prevention & control*; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000002:abnormalities; D008297:Male; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011296:Prenatal Diagnosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013526:Surgical Mesh / Q000706:statistics & numerical data; D013997:Time Factors