Porcine dermal patches as a risk factor for recurrence after congenital diaphragmatic hernia repair

Jorge, Irene de Haro; Ortells, Jordi Prat; Martín-Solé, Oriol; Fernandez, Elena Muñoz; Pertierra, Africa; Martín-Lluís, Alba; Tarrado, X

doi:10.1007/s00383-020-04787-w

Cited by 5 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Re-recurrence rates of up to 67% have been reported (28). More recently, the use of biological patches has even been disapproved due to significantly higher recurrence rates (60). In our cohort, solely non-absorbable material was used for patch implantation (Gore-Tex Dualmesh R ), which might also have an impact on our low overall recurrence and re-recurrence rates.…”

Section: Patient Characteristics and Treatment Of Cdhmentioning

confidence: 73%

Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open Repair of Congenital Diaphragmatic Hernia—A Large Prospective, Observational Cohort Study at One Referral Center

et al. 2021

View full text Add to dashboard Cite

Objective: After neonatal repair of congenital diaphragmatic hernia (CDH) recurrence is the most severe surgical complication and reported in up to 50% after patch implantation. Previous studies are difficult to compare due to differences in surgical techniques and retrospective study design and lack of standardized follow-up or radiologic imaging. The aim was to reliably detect complication rates by radiologic screening during longitudinal follow-up after neonatal open repair of CDH and to determine possible risk factors.Methods: At our referral center with standardized treatment algorithm and follow-up program, consecutive neonates were screened for recurrence by radiologic imaging at defined intervals during a 12-year period.Results: 326 neonates with open CDH repair completed follow-up of a minimum of 2 years. 68 patients (21%) received a primary repair, 251 (77%) a broad cone-shaped patch, and 7 a flat patch (2%). Recurrence occurred in 3 patients (0.7%) until discharge and diaphragmatic complications in 28 (8.6%) thereafter. Overall, 38 recurrences and/or secondary hiatal hernias were diagnosed (9% after primary repair, 12.7% after cone-shaped patch; p = 0.53). Diaphragmatic complications were significantly associated with initial defect size (r = 0.26). In multivariate analysis left-sided CDH, an abdominal wall patch and age below 4 years were identified as independent risk factors. Accordingly, relative risks (RRs) were significantly increased [left-sided CDH: 8.5 (p = 0.03); abdominal wall patch: 3.2 (p < 0.001); age ≤4 years: 6.5 (p < 0.002)]. 97% of patients with diaphragmatic complications showed no or nonspecific symptoms and 45% occurred beyond 1 year of age.Conclusions: The long-term complication rate after CDH repair highly depends on surgical technique: a comparatively low recurrence rate seems to be achievable in large defects by implantation of a broad cone-shaped, non-absorbable patch. Longitudinal follow-up with regular radiologic imaging until adolescence is essential to reliably detecting recurrence to prevent acute incarceration and chronic gastrointestinal morbidity with their impact on prognosis. Based on our findings and literature review, a risk-stratified approach to diaphragmatic complications is proposed.

show abstract

Section: Patient Characteristics and Treatment Of Cdhmentioning

confidence: 73%

Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open Repair of Congenital Diaphragmatic Hernia—A Large Prospective, Observational Cohort Study at One Referral Center

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This pattern appears to be validated by a recent study suggesting that porcine dermal patches are a significant factor for recurrence when compared to Gore-tex patches. 27 There is however no complete consensus; a meta-analysis from 2012 concluded that there is no difference in recurrence rates between the use of Surgisis (porcine intestinal submucosa) and Gore-tex when used for Congenital DH. 28 Other small studies have suggested that biological meshes may yet have a role.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review Examining the Experimental Methodology Behind In Vivo Testing of Hiatus Hernia and Diaphragmatic Hernia Mesh

Whitehead-Clarke

Beynon

Banks

et al. 2022

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Introduction Mesh implants are regularly used to help repair both hiatus hernias (HH) and diaphragmatic hernias (DH). In vivo studies are used to test not only mesh safety, but increasingly comparative efficacy. Our work examines the field of in vivo mesh testing for HH and DH models to establish current practices and standards. Method This systematic review was registered with PROSPERO. Medline and Embase databases were searched for relevant in vivo studies. Forty-four articles were identified and underwent abstract review, where 22 were excluded. Four further studies were excluded after full-text review—leaving 18 to undergo data extraction. Results Of 18 studies identified, 9 used an in vivo HH model and 9 a DH model. Five studies undertook mechanical testing on tissue samples—all uniaxial in nature. Testing strip widths ranged from 1–20 mm (median 3 mm). Testing speeds varied from 1.5–60 mm/minute. Upon histology, the most commonly assessed structural and cellular factors were neovascularisation and macrophages respectively (n = 9 each). Structural analysis was mostly qualitative, where cellular analysis was equally likely to be quantitative. Eleven studies assessed adhesion formation, of which 8 used one of four scoring systems. Eight studies measured mesh shrinkage. Discussion In vivo studies assessing mesh for HH and DH repair are uncommon. Within this relatively young field, we encourage surgical and materials testing institutions to discuss its standardisation.

show abstract

“…The need for ECMO could independently increase the risk of recurrence or indicate a more severe clinical presentation with a larger defect size ( 2 ). Moreover, the recurrence rate is not associated with the repair timing (before, during, or after ECMO) and the need for the “EXIT to ECMO” procedure ( 2 , 47 , 48 ). However, these results are biased by the lack of standardized long-term follow-up in some series ( 2 , 49 ).…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Since recurrence could occur at any time during the years following primary repair, it would be helpful to promote a remote follow-up that includes a multidisciplinary team of neonatologists, pediatrics, and pediatric surgeons at 3, 6, 12, 18, 24 months of life and then annually until the age of 8 years ( 12 , 47 ). In addition, standardization of clinical and radiological assessments should be implemented, even for asymptomatic patients ( 5 , 47 ). CXR should be scheduled at 12 and 24 months and performed anytime as needed, based on the patient's clinical symptoms.…”

Section: Clinical Presentation and Follow-up For Timely Diagnosis Of ...mentioning

confidence: 99%

“…CXR should be scheduled at 12 and 24 months and performed anytime as needed, based on the patient's clinical symptoms. Then, it should be planned every 2 years until 8 years old for primary closure, with an additional 18-month CXR for patients undergoing patch repair ( 47 ). The preferred diagnostic exams to detect a CDH recurrence are the upper gastrointestinal (UGI) contrast study, barium enema, and computed tomography (CT) scan ( 54 ).…”

Section: Clinical Presentation and Follow-up For Timely Diagnosis Of ...mentioning

confidence: 99%

See 1 more Smart Citation

Recurrence of Congenital Diaphragmatic Hernia: Risk Factors, Management, and Future Perspectives

et al. 2022

View full text Add to dashboard Cite

Recurrence is one of the most common surgical complications in Congenital Diaphragmatic Hernia (CDH). It could remain clinically silent for a long time or present as an acute complication week, months, or even years after the primary surgery. Several risk factors have been identified so far. An extended diaphragmatic defect represents one of the leading independent risk factors, together with indirect signs of large defect such as the liver position related to the diaphragm and the use of the prosthetic patch and with the use of a minimally invasive surgical (MIS) approach. However, the exact contribution of each factor and the overall risk of recurrence during the life span still need to be fully understood. This mini-review aims to give an overview of the current knowledge regarding CDH recurrence, focusing on predisposing factors, clinical presentation, management and follow-up of high-risk patients, and future perspectives.

show abstract

Porcine dermal patches as a risk factor for recurrence after congenital diaphragmatic hernia repair

Cited by 5 publications

References 30 publications

Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open Repair of Congenital Diaphragmatic Hernia—A Large Prospective, Observational Cohort Study at One Referral Center

Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open Repair of Congenital Diaphragmatic Hernia—A Large Prospective, Observational Cohort Study at One Referral Center

A Systematic Review Examining the Experimental Methodology Behind In Vivo Testing of Hiatus Hernia and Diaphragmatic Hernia Mesh

Recurrence of Congenital Diaphragmatic Hernia: Risk Factors, Management, and Future Perspectives

Contact Info

Product

Resources

About