Musculoskeletal abnormalities in congenital diaphragmatic hernia survivors: Patterns and risk factors: Report of a <scp>Japanese</scp> multicenter follow‐up survey

Takayasu, Hajime; Masumoto, Kouji; Goishi, Keiji; Hayakawa, Masahiro; Tazuke, Yuko; Yokoi, Akiko; Terui, Keita; Okuyama, Hiroomi; Usui, Noriaki; Nagata, Kouji; Taguchi, Tomoaki

doi:10.1111/ped.12922

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…Another weakness of this study is the absence of very long-term follow-up, i.e. after the end of growth, in order to evaluate the consequences of the patch use on the occurrence of chest deformities, scoliosis and pectus excavatum [21,22]. These issues might be solved in a long-term prospective cohort specifically designed to raise these concerns.…”

Section: Discussionmentioning

confidence: 99%

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

Suply

Rees

Cross

et al. 2020

Journal of Pediatric Surgery

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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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Section: Discussionmentioning

confidence: 99%

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

Suply

Rees

Cross

et al. 2020

Journal of Pediatric Surgery

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“…18 Chest wall deformities and scoliosis often develop in patients with CDH. 5,19,20 Whether these are mainly associated with the embryology of CDH or are related to the type of repair remains controversial. CDH-associated pulmonary hypoplasia, decreased pulmonary compliance, and higher negative pressure can lead to musculoskeletal deformities.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after Split Abdominal Wall Muscle Flap Repair for Large Congenital Diaphragmatic Hernias

et al. 2019

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Introduction Repair of large congenital diaphragmatic hernias (CDHs) is challenging. As primary repair is not always feasible, patches are commonly used. An alternative treatment is split abdominal wall muscle flap repair, which uses vascularized autologous tissue. The aim of this study was to analyze the long-term outcome of large CDH defects undergoing split abdominal wall muscle repair. Materials and Methods This is a retrospective review (2003–2016) of large CDH treated by split abdominal wall muscle flap repair. Results In a total of 107 CDH patients, the abdominal muscle flap technique was used in 10 (9.3%); 7 had been prenatally treated with tracheal occlusion. Two patients experienced recurrence at 2 months and 6 years, respectively. Only one patient required abdominoplasty due to abdominal wall muscle weakness. Two patients developed progressive scoliosis; one of them required orthopaedic treatment. Minor chest wall deformities were detected in seven, but only one required orthopaedic treatment. The lung-to-head ratio was 0.79 in patients developing musculoskeletal deformities, and 1.5 in those without this complication (p < 0.05). Median follow-up was 11.2 years (3.5–14.2), and all patients were alive at the time of writing this article. Conclusion The split abdominal wall muscle flap technique is a valid option for repair of large CDH. Associated musculoskeletal deformities seem to be influenced not only by the repair technique used but also by the degree of pulmonary hypoplasia and inherent pathophysiological changes.

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“…This synthetic durable material has a compliance that is different from diaphragmatic tissue, which may hamper fluid diaphragmatic movements (Mayer et al, ; Touloukian, ). Furthermore, it is not remodelled and does not grow with the neonate, thus potentially leading to reherniation, chest wall, and spinal deformities (Gasior & St Peter, ; Takayasu et al, ). However, in this rabbit model—similar to several large volume centres—rates of reherniation following patch repair are low (Jawaid et al, ; Tsai et al, ).…”

Section: Discussionmentioning

confidence: 99%

Providing direction improves function: Comparison of a radial pore-orientated acellular collagen scaffold to clinical alternatives in a surgically induced rabbit diaphragmatic tissue defect model

Eastwood

Daamen

Joyeux

et al. 2018

J Tissue Eng Regen Med

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Gore-Tex® is a widely used durable patch for repair of congenital diaphragmatic defects yet may result in complications. We compared Gore-Tex with a composite of a radial pore-orientated collagen scaffold (RP-Composite) and clinically used porcine small intestinal submucosa (SIS; Surgisis®) in a rabbit model for diaphragmatic hernia. The growing rabbit mimics the rapid rib cage growth and reherniation rates seen in children. We created and immediately repaired left hemidiaphragmatic defects in 6-week-old rabbits with Gore-Tex, SIS, and an RP-Composite scaffold. An additional group of rabbits had a sham operation. At 90 days, survivors more than doubled in weight. We observed few reherniations or eventrations in Gore-Tex (17%) and RP-Composite (22%) implanted animals. However, SIS failed in all rabbits. Maximum transdiaphragmatic pressure was lower in Gore-Tex (71%) than RP-Composite implanted animals (112%) or sham (134%). Gore-Tex repairs were less compliant than RP-Composite, which behaved as sham diaphragm (p < 0.01). RP-Composite induced less foreign body giant cell reaction than Gore-Tex (p < 0.05) with more collagen deposition (p < 0.001), although there was a tendency for the scaffold to calcify. Unlike Gore-Tex, the compliance of diaphragms reconstructed with RP-Composite scaffolds were comparable with native diaphragm, whereas reherniation rates and transdiaphragmatic pressure measurements were similar.

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Musculoskeletal abnormalities in congenital diaphragmatic hernia survivors: Patterns and risk factors: Report of a Japanese multicenter follow‐up survey

Abstract: Approximately one-quarter of the survivors developed musculoskeletal abnormalities in the present survey of CDH patients. These data suggest that each musculoskeletal abnormality has its own specific predictors.

Cited by 14 publications

References 22 publications

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

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

Outcomes after Split Abdominal Wall Muscle Flap Repair for Large Congenital Diaphragmatic Hernias

Providing direction improves function: Comparison of a radial pore-orientated acellular collagen scaffold to clinical alternatives in a surgically induced rabbit diaphragmatic tissue defect model

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