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

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. Green open access

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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.

Type: Article
Title: Patch repair of congenital diaphragmatic hernia is not at risk of poor outcomes
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jpedsurg.2019.10.021
Publisher version: https://doi.org/10.1016/j.jpedsurg.2019.10.021
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: congenital diaphragmatic hernia, recurrence, patch, Levels of evidence : level III cohort study
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10083396
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