Suply, E;
Rees, C;
Cross, K;
Elagami, H;
Blackburn, S;
Giuliani, S;
D'Souza, R;
... De Coppi, P; + view all
(2020)
Patch repair of congenital diaphragmatic hernia is not at risk of poor outcomes.
Journal of Pediatric Surgery
, 55
(8)
pp. 1522-1527.
10.1016/j.jpedsurg.2019.10.021.
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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 analysed (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.
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