J Pediatr Surg. 2019 Nov 1. pii: S0022-3468(19)30756-0. doi: 10.1016/j.jpedsurg.2019.10.021. [Epub ahead of print]

https://www.ncbi.nlm.nih.gov/pubmed/31711747

Patch repair of congenital diaphragmatic hernia is not at risk of poor outcomes.

Suply E¹, Rees C¹, Cross K¹, Elagami H¹, Blackburn S¹, Giuliani S¹, D’Souza R², David AL³, Deprest J³, Curry J¹, Eaton S⁴, De Coppi P⁵.

Author information

Abstract

PURPOSE:

Recurrence of congenital diaphragmatic hernia (CDH) was retrospectively evaluated after correction with or without a patch in an institution where tension-free repair is advocated.

METHODS:

Demographics and outcomes of patients with a postero-lateral CDH repaired (2000-2016) were analyzed (univariate tests and binary logistic regression adjusting for time since start of study, gender, defect side, liver herniation, patch, surgical approach, absence of postero-lateral rim and length of follow-up).

RESULTS:

Of 203 patients, 107 received a patch (P), and 96 were not patched (NP). Groups were not different for gestational age birthweight, gender, defect side and minimally invasive approach rate. Preoperative ECMO incidence (P:29.9% vs. NP:2.1%, p < 0.01), liver herniation (P:57.0% vs. NP:22.9%, p < 0.01) and absence of a postero-lateral rim (P:61.7% vs. NP:8.3%, p < 0.01) were higher in the P group. The mortality rate was 10.8% (P:15.0% vs. NP:6.2%, p = 0.07). Recurrence was not different (P:9.3% vs. NP:4.2%, p = 0.15). Multivariate analysis showed that recurrence was higher after thoracoscopy compared to open (OR = 12.2 [2.2-68], p < 0.01); neither the use of patch (OR = 2.3, [0.5-10.4], p = 0.28) nor any other factors were associated with recurrence.

CONCLUSION:

In this single centre series where tension-free repair was advocated, patch repair of CDH was not associated with higher recurrence, though access route was.

TYPE OF STUDY:

Cohort Study.

LEVEL OF EVIDENCE:

Level III.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

Congenital diaphragmatic hernia; Patch; RecurrencePMID: 31711747 DOI: 10.1016/j.jpedsurg.2019.10.021