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
