J Pediatr Surg
. 2026 Feb 12;61(5):162926.
doi: 10.1016/j.jpedsurg.2026.162926. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41690378/
Biologic versus synthetic patches: A systematic review and comparative meta-analysis of repair strategies for neonatal congenital diaphragmatic hernia
Alana Larissa Aparecida Marques 1, Itzel Elizabeth Vidal-Sanchez 2, Marcella Mota Constante 3, Carolina Cantarini Aguiar 1, Ashwin Pimpalwar 4
Affiliations Expand
- PMID: 41690378
- DOI: 10.1016/j.jpedsurg.2026.162926
Abstract
Background: Congenital diaphragmatic hernia (CDH) is a severe neonatal condition frequently requiring patch repair, yet the optimal prosthetic material remains contested. Synthetic patches offer structural durability but are associated with foreign body reactions, while biologic patches may promote tissue integration but raise concerns regarding long-term recurrence.
Methods: We conducted a systematic review and meta-analysis of observational studies comparing biologic versus synthetic patch repair in neonates with CDH. Databases were searched through May 2025 per PRISMA guidelines. The primary outcome was hernia recurrence. Secondary outcomes were small bowel obstruction (SBO), mortality, extracorporeal membrane oxygenation (ECMO), length of hospital stay (LOS), and duration of mechanical ventilation. Not all studies reported every secondary outcome; therefore, the number of studies contributing to each pooled analysis varied. Pooled odds ratios (ORs) and mean differences (MDs) were calculated using random-effects models. Risk of bias was assessed via ROBINS-I.
Results: Seventeen studies comprising 608 neonates (biologic: n = 249; synthetic: n = 359) met inclusion criteria. No statistically significant differences were observed in recurrence (OR 2.17, 95 % CI: 0.95-4.96), SBO (OR 2.29, 95 % CI: 0.74-7.05), mortality (OR 1.26, 95 % CI: 0.57-2.79), ECMO use (OR 0.86, 95 % CI: 0.16-4.65), LOS (MD -7.75 days, 95 % CI: -22.68 to 7.18), or ventilation days (MD -5.46, 95 % CI: -19.55 to 8.62).
Conclusions: Biologic and synthetic patches demonstrate comparable short- and mid-term outcomes following neonatal CDH repair. In the absence of clear clinical superiority, prosthesis selection should be individualized based on defect characteristics and perioperative context. High-quality, prospective, multicenter studies are warranted to inform material-specific recommendations.
Keywords: Biologic patch; Congenital diaphragmatic hernia; Hernia recurrence; Meta-analysis; Neonatal; Neonatal surgery; Patch repair; Surgical outcomes; Synthetic patch; Systematic review.
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