Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

“…The supportive literature for patch use in CDH consists of cohort studies of low quality. 55,56,[60][61][62] We endorse the use of tension-free or cone-shaped polytetrafluorethylene/ GORE-TEX patches, because of the accumulated experience with their use. We specifically advocate against the use of intestinal submucosal patches alone, as they are associated with an unacceptably high rate of recurrence.…”

Reoperations in High Risk Group Children With Congenital Diaphragmatic Hernia

“…Стосов-но ризику виникнення рецидиву, розмір дефекту також відіграє провідну роль. Пластика діафраг-ми з використанням синтетичних матеріалів су-проводжується рецидивами у половини пацієнтів перших 3 років життя, у багатьох пацієнтів вини-кають повторні рецидиви [7]. Зокрема, у нашому дослідженні, у пацієнта з агенезією лівого куполу діафрагми та первинною пластикою з використан-ням синтетичної латки ePTFE, оперативне ліку-вання з приводу рецидиву виконано двічі -у віці 6 місяців та 1 рік.…”

Congenital Diaphragmatic Hernia: State of the Art Reconstruction- Biologics Versus Synthetics

“…Synthetic patch repairs emerged historically as the predominant method of tension-free closure of defects not amenable to primary repair (Levison et al, 2006). Despite three decades of experience with synthetic patches, which offer a superb short term solution, recurrence rates are reported as high as 41% -46% at a median follow up of 12 months (Moss et al, 2001;Jancelewicz et al, 2010), compared to 10-22% rate following primary closure in long-term survivors (Jancelewicz et al, 2010;Cohen & Reid, 1981). Long-term studies showed that prosthetic grafts can result in recurrences in up to 50% of patients by 3 years of age (Moss et al, 2001).…”

“…Only the history of a patch repair was independently predictive of a subsequent diaphragmatic hernia recurrence when compared to multiple prenatal markers of CDH severity in a multivariant regression analysis (Jancelewicz et al, 2010). The higher rates of recurrence in synthetic patch repairs are thought to be secondary to a lack of tissue incorporation and inability to accommodate growth, so that tension over time causes the patches to separate from the thoracic wall as well as lead to chest wall deformities.…”

“…Graft failures occurred early with 92% of Surgisis® failures and 75% of GoreTex® failures within 1 year. A Surgisis® repair was associated with higher frequency of operative bowel obstruction, (Jancelewicz et al, 2010;St. Peter SD et al, 2007) and was possibly proinflammatory (Baroncello JB et al, 2008).…”