J Pediatr Surg. 2019 Aug 30. pii: S0022-3468(19)30582-2. doi: 10.1016/j.jpedsurg.2019.08.042. [Epub ahead of print]
https://www.ncbi.nlm.nih.gov/pubmed/31515112
Flap repair in congenital diaphragmatic hernia leads to lower rates of recurrence.
Dewberry L1, Hilton S2, Gien J3, Liechty KW4, Marwan AI4.
Author information
1University of Colorado, Department of Surgery, Aurora, (CO,) USA. Electronic address: Lindel.dewberry@ucdenver.edu.2University of Colorado, Department of Surgery, Aurora, (CO,) USA.3University of Colorado, Department of Pediatrics, Division of Neonatology, Aurora, (CO,) USA; University of Colorado School of Medicine, Colorado Fetal Care Center, Aurora, (CO,) USA.4University of Colorado School of Medicine, Colorado Fetal Care Center, Aurora, (CO,) USA; University of Colorado, Department of Surgery, Division of Pediatric Surgery, Aurora, (CO,) USA.
Abstract
BACKGROUND:
Congenital diaphragmatic hernia (CDH) repair is technically challenging with different approaches for repair. The aim of this study was to compare outcomes between patch and flap repair.
METHODS:
CDH repairs performed at a quaternary care children’s hospital between 2008 and 2018 were reviewed. Seventy CDH repairs were analyzed after primary repairs were excluded (n = 52). Analysis included proportions or median with interquartile range and chi-square or Wilcoxon rank-sum test.
RESULTS:
Comparing patch and flap repairs, demographic characteristics and hernia parameters were similar. Examining outcomes, length of stay, 30-day mortality, and 1-year mortality were all similar between groups, but total/symptomatic recurrence was higher in the patch group (10%/7% vs. 3%/0%), and the median time to recurrence was 3 months. A sub-analysis comparing those who recurred to those who did not demonstrated no significant difference between the two groups.
CONCLUSION:
Patients who undergo flap repair have a lower risk of recurrence compared to those who undergo patch repair, and this may be due to the ability of the flap to grow over time with the child.
TYPE OF STUDY:
Treatment Study.
LEVEL OF EVIDENCE:
III.
Copyright © 2019. Published by Elsevier Inc.
KEYWORDS:
Congenital diaphragmatic hernia; Patch; Transversus flapPMID: 31515112 DOI: 10.1016/j.jpedsurg.2019.08.042
