title: Computed Tomographic Study of the Pediatric Diaphragmatic Growth: Application to the Treatment of Congenital Diaphragmatic Hernia.
abstract: BackgroundThe prosthesis commonly used for the treatment of congenital diaphragmatic hernia (CDH) lacks elasticity to replace the diaphragm's mechanical properties and does not follow the natural growth of the child treated.ObjectiveTo determine the appropriate properties required for the prostheses, a CT study on healthy patients was conducted.MethodsTwo methods of diaphragmatic surface analysis are assessed: the diaphragmatic surface is either estimated using surface 2D estimations (method 1), or calculated using length measures on thoracoabdominal CT scans from children (method 2). Patients are divided into two groups depending on their age: group 1:n= 9; median age: 2.0 months (0.1-9.5); group 2:n= 9; median age: 182.6 months (158.5-235.5). Growth factor between the two groups is calculated and the two methods are statistically compared.ResultsThe ratio group 2/group 1 of the diaphragmatic surfaces was 4.3 ± 0.2 on the left side and 4.0 ± 0.2 on the right side for method 1, and 5.1 ± 0.2 on the left side and 5.1 ± 0.3 on the right side for method 2. The difference in the median values between both methods is statistically significant for both the left and right sides (p= 0.022 andp= 0.002, respectively). Hence, the two methods cannot be used exchangeably.ConclusionThe treatment of CDH with large defect remains a challenge because of the high incidence of hernia recurrence probably due to prosthesis defect; thus it is important to estimate the diaphragmatic surface precisely. We aim to develop a prosthesis material that can be commonly used and found a mean diaphragmatic growth factor of approximately 4 to 5 from early childhood to adolescence.
authors.affiliation: Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Pediatric Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France.
authors.forename: Meriam
authors.initials: M
authors.lastname: Koob
authors.affiliation: INSERM UMR 1121 Biomatériaux et Bioingénierie Tissulaire, Universite de Strasbourg, Strasbourg, Alsace, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sananes
authors.affiliation: INSERM UMR 1121 Biomatériaux et Bioingénierie Tissulaire, Universite de Strasbourg, Strasbourg, Alsace, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Senger
authors.affiliation: INSERM UMR 1121 Biomatériaux et Bioingénierie Tissulaire, Universite de Strasbourg, Strasbourg, Alsace, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hemmerlé
authors.affiliation: Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Becmeur
mesh_terms: D000293:Adolescent; D003964:Diaphragm / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000254:growth & development*; D065630:Hernias, Diaphragmatic, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D019736:Prostheses and Implants / Q000009:adverse effects; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*