Article
10 year-experience with the cone-shaped patch in surgical correction of congenital diaphragmatic hernia in neonates – significant reduction of recurrence rate
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Authors
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Katrin Zahn
- UMM Mannheim, Kinderchirurgische Klinik, Mannheim, Deutschland
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Thomas Schaible
- UMM Mannheim, Neonatologie, Mannheim, Deutschland
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Lucas M. Wessel
- Uniklinik Mannheim, Kinderchirurgie, Mannheim, Deutschland
| Published: | April 21, 2016 |
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Outline
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Background: Congenital diaphragmatic hernia is a rare anomaly. Diaphragmatic reconstruction in large defects requires implantation of patches. Different materials have been used and different techniques of implantation have been described. Recurrence rates of a varying degree are reported in literature, ranging from below 5% in primary repairs to up to 80% in patients after patch repair. Over the years still similar recurrence rates are reported in open surgery in literature, with more recurrences being observed after minimally invasive surgery (MIS) also in small diaphragmatic defects.
Materials and methods: The cone-shaped patch was first published in 2005 (Loff et al.). Between 2003 and 2012 509 patients were treated at our institution. 200 patients received ECMO-therapy. 444 patients underwent surgical closure of the diaphragm and in 310 patients a cone-shaped patch was used. Surviving patients were reassessed regularly for recurrence in our longitudinal follow-up program.
Results: Survival in this cohort was 78,6%. Early recurrence within the first hospital stay was only observed occasionally. Most recurrences were detected within the first 2 years of life (39/44 patients). Results for different surgical techniques and depending on defect size (Boston scale) are presented. Recurrence was mainly observed in large defects in open surgery, while recurrence was also observed in small defects after MIS-repair. Overall recurrence in patients with cone-shaped patches was 10% (as well in open and minimally invasive surgery). The observation period was shorter in minimally invasive surgery (max. 6 years).
Conclusion: Longterm-results after congenital diaphragmatic hernia repair in large defects highly depend on technique of implantation and material of patch. With the use of a cone-shaped Goretex®-patch the longterm-recurrence rate could be lowered significantly to 10% within an observation period of a minimum of 2 to a maximum of 10 years. Also in minimally invasive surgery the cone-shaped patch seems to be advantageous, although longterm results have yet to be awaited. We recommend using a cone-shaped patch in surgical repair of large diaphragmatic defects to prevent recurrence.
