title: Delayed abdominal closure after congenital diaphragmatic hernia repair.
abstract: OBJECTIVE
  We present our experience with CDH patients who required delayed abdominal closure following CDH repair.
  
  
  METHODS
  A retrospective review of all CDH repairs from 2004 to 2014 was performed.
  
  
  RESULTS
  233 patients underwent CDH repair, of which 21 required delayed abdominal closure defined as the inability to close the abdominal fascia at the time of CDH repair. The incidence of delayed closure was higher in those undergoing CDH repair on ECMO vs. not on ECMO (40% [17/43] vs. 2% [4/190]; P<0.001). The abdominal wound was temporarily covered by skin only (n=2), skin+prosthetic mesh sutured to the fascia (n=3), preformed silo (n=9), or vacuum assisted closure (VAC®) device (n=7). The mean time to fascial closure was 14.5±7 and 6±3days for patients repaired on ECMO and not on ECMO, respectively. In patients repaired on ECMO, the "primary closure" and "delayed closure" groups were not different in prenatal predictors (liver up, lung-to-head ratio [LHR]), total days on ECMO, ECMO days prior to CDH repair, and survival. In patients repaired on ECMO, the "delayed closure" group had a significantly higher requirement for blood transfusions compared to the "primary closure" group (mean 87±35 vs. 62±27ml of packed RBCs per ECMO day; P=0.01).
  
  
  CONCLUSIONS
  Delayed abdominal closure was required in 40% of CDH repairs done on ECMO but was rarely required in CDH repairs performed off ECMO. Although associated with an increased need for blood transfusions, delayed closure following CDH repair on ECMO was not associated with increased mortality.
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
authors.forename: Pablo
authors.initials: P
authors.lastname: Laje
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States. Electronic address: peranteauw@email.chop.edu.
authors.forename: William H
authors.initials: WH
authors.lastname: Peranteau
mesh_terms: D058107:Abdominal Wound Closure Techniques; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery* / Q000628:therapy; D059685:Herniorrhaphy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Congenital diaphragmatic hernia; Delayed abdominal closure; Extracorporeal membrane oxygenation; Open abdomen