Outcome of Congenital Diaphragmatic Hernia Repair Depending on Patch Type

Laituri, C A; Garey, Carissa L.; Valusek, Patricia A.; Fike, Frankie B.; Kaye, Adam J.; Ostlie, Daniel J.; Snyder, Charles L.; Peter, Shawn D. St.

doi:10.1055/s-0030-1261939

Cited by 52 publications

(24 citation statements)

References 9 publications

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“…It is sutured to the rims of the orifice with interrupted sutures and, to avoid excessive tension and enlargement of the hemi-thorax, cone-shaping of the patch can be beneficial [ 226 ]. The use of a patch seems to increase the risk of re-herniation [ 227 - 230 ] although it should be acknowledged that patients requiring a patch have larger defects which entail higher morbidity [ 59 ]. Abdominal wall or latissimus dorsi muscle flaps have also been used for CDH repair [ 231 - 234 ].…”

Section: Disease Name/synonymsmentioning

confidence: 99%

Congenital Diaphragmatic Hernia

Tovar

2012

Orphanet Journal of Rare Diseases

198

175

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Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is < 5 in 10,000 live-births. The etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Antenatal diagnosis is often made and this allows prenatal management (open correction of the hernia in the past and reversible fetoscopic tracheal obstruction nowadays) that may be indicated in cases with severe lung hypoplasia and grim prognosis. Treatment after birth requires all the refinements of critical care including extracorporeal membrane oxygenation prior to surgical correction. The best hospital series report 80% survival but it remains around 50% in population-based studies. Chronic respiratory tract disease, neurodevelopmental problems, neurosensorial hearing loss and gastroesophageal reflux are common problems in survivors. Much more research on several aspects of this severe condition is warranted.

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Section: Disease Name/synonymsmentioning

confidence: 99%

Congenital Diaphragmatic Hernia

Tovar

2012

Orphanet Journal of Rare Diseases

198

175

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“…Interestingly, whatever diaphragmatic reconstruction method has been used in the presented study, few to no bowel adhesions were observed. This is of particular interest because adhesive small bowel obstruction after CDH repair has been clinically reported in a considerable number of cases, irrespective of the type of surgery [ 43 , 44 ]. The paucity of intestinal adhesions in our study could be due to the use of polyglecaprone sutures because of its anti-inflammatory properties [ 45 ] and the surgical access of thoracotomy, which is rarely used clinically [ 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model

et al. 2015

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BackgroundNeonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes.Materials and Methods2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue.ResultsOverall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05).ConclusionsMatricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair.

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“…Adhesions are a common problem in abdominal surgery. Abdominal surgeries for recurrences of diaphragmatic hernia and small bowel obstruction in patients operated on for congenital diaphragmatic hernia were required in 67% and 48% of defects closed with non-absorbable and biosynthetic patches, respectively (Laituri et al, 2010). St Peter et al found small bowel obstructions in 31% and 9% of patients whose congenital diaphragmatic hernia was repaired using SIS or non-absorbable synthetic patches, respectively (St Peter et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…Degradable biological material has the advantage of being replaceable with the patient's own tissueand can thus grow with the infant. In clinical studies, however, implantation of small intestinal mucosa (SIS) and other absorbable patches did not lower recurrence rates compared to closures with non-absorbable patches such as PTFE (Grethel et al, 2006;Jancelewicz et al, 2010;St Peter et al, 2007;Laituri et al, 2010). For instance, Jancelewicz et al showed recurrence within six months in a third of infants after repair with an SIS patch (Jancelewicz et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Repair of surgically created diaphragmatic defect in rat with use of a crosslinked porous collagen scaffold

Brouwer

Daamen

Reijnen

et al. 2012

J Tissue Eng Regen Med

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Large defects in congenital diaphragmatic hernia are closed by patch repair, which is associated with a high complication risk and reherniation rate. New treatment modalities are warranted. We evaluated the feasibility of using an acellular biodegradable collagen bioscaffold for a regenerative medicine approach to close a surgically created diaphragmatic defect in a rat model. Scaffold degradation, cellular ingrowth and regeneration of the diaphragm were studied. In 25 rats, a subcostal incision was made and one third of the right hemidiaphragm was resected. Crosslinked porous type I collagen scaffolds (Ø ~ 14 mm) were sutured into the lesion. Rats were sacrificed at 2, 4, 8, 12 or 24 weeks after scaffold implantation. Implants were evaluated macroscopically and (immuno)histologically. Survival after surgery was 88% with no evidence of reherniation. Histological examination showed that the collagen scaffold degraded slowly and new collagen, elastin and mesothelium were deposited. Blood vessels were observed primarily at the outer borders of the scaffold; their number gradually increased in time. Muscle fibres were found on the scaffold covering up to 10% of the defect. Macroscopically, adhesion of the scaffold to the liver was observed. Use of a collagen scaffold to close a surgically created diaphragmatic defect is feasible, with evidence of new tissue formation. The use of crosslinked collagen scaffolds allows targeted modification; e.g. addition of growth factors to further stimulate growth of muscle cells.

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Outcome of Congenital Diaphragmatic Hernia Repair Depending on Patch Type

Cited by 52 publications

References 9 publications

Congenital Diaphragmatic Hernia

Congenital Diaphragmatic Hernia

Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model

Repair of surgically created diaphragmatic defect in rat with use of a crosslinked porous collagen scaffold

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