The use of implants for surgical treatment of congenital diaphragmatic hernia in newborns

Abstract

Применение имплантов в коррекции диафрагмальной грыжи у новорожденныхThe use of implants for surgical treatment of congenital diaphragmatic hernia in newborns Врожденная диафрагмальная грыжа (ВДГ) -патология, которая требует обязательной хирургической коррек-ции. При значительных дефектах диафрагмы, например аплазии ее купола, зачастую возникает необходимость в использовании имплантационных материалов. До сих пор нет единой точки зрения по вопросу выбора имплан-та. В статье представлены результаты сравнительного анализа лечения новорожденных (n = 40) с левосторонней ложной ВДГ. Всем пациентам была выполнена торакоскопическая пластика купола дифрагмы. По типу использо-ванного имплантационного материала детей разделили на две группы: для первой (n = 16) применяли синтетичес-кие импланты «Экофлон» («НПК "Экофлон"», Россия), для второй (n = 24) -биологические импланты Permacol (Tissue Science Laboratories, Великобритания). Результаты исследования показали преимущества биологичес-кого импланта: время операции при его использовании было меньше (106 мин против 144 мин при использова-нии «Экофлона», p <0,05); число рецидивов -также меньше (28 % против 54 %, однако p >0,05); случаев от-торжения импланта не было (при использовании «Экофлона» у двух пациентов началось воспаление, p <0,05).Congenital diaphragmatic hernia (CDH) is an absolute indication for surgical treatment. In case of extensive defects of the diaphragm, such as diaphragmatic aplasia, the use of implants is required. So far, there is no unanimous opinion on the type of the implant. The article presents a comparative analysis of treatment of 40 newborns with left pseuso-CDH. All patients received thoracoscopic repair of the diaphragmatic cupula. The patients were divided into two groups according to the type of the implant: 16 newborns received Ecoflon synthetic implants (Ecoflon Scientific and Production Complex, Russia) and 24 newborns received Permacol biologic implants (Tissue Science Laboratories, UK). The study demonstrated the advantage of the biologic implant over the synthetic one: the surgery took less time (106 minutes compared to 144 minutes with Ecoflon, p <0.05); relapses were also more rare (28 % and 54 %, respectively; however, p was >0.05); no implant rejection was observed (with Ecoflon, two patients responded with inflammation, p <0.05).Ключевые слова: новорожденные, врожденная диафрагмальная грыжа, торакоскопия, имплант, имплантационный материал, «Экофлон», Permacol

Synthetic versus Biological Patches for CDH: A Comparison of Recurrence Rates and Adverse Events, Systematic Review, and Meta-Analysis

“…Single case reports Shariff 2014, 33 Riquelme 2015, 19 Premkumar 2015, 21 Hutson 1985, 35 Gander 2010, 41 Davis 2002, 42 Cantone 2014, 25 Bruen 2007, 36 Becmeur 2001, 26 Bawazir 2019 43 22 Glick 1992, 23 Ahmed 1998 44 Retrospective case series with research questions and outcomes Yokota 2014, 27 Weaver 2006, 45 Tsai 2012, 18 Shah 2009, 46 Russel 2014, 40 Romao 2012, 14 Riehle 2007, 20 Razumovskly 2016, 11 Nasr 2010, 17 Mitchell 2008, 15 McHoney 2010, 47 Loff 2005, 7 Laituri 2010, 13 Kuklová 2011, 38 Koziarkiewicz 2014, 39 Koot 1993, 48 Kamran 2018, 49 Jawaid 2013, 9 Janssen 2018, 30 Jancelewicz 2013, 12 Grethel 2006, 5 Heiwegen 2020, 28 Guner 2008, 29 Dewberry 2019, 37 de Kort 1996, 24 D'agostino 1995, 31 Cho 2009, 50 Barnhart 2012, 16 Baerg 2012, 32 Aydin 2020 51 34 Rygl 2012, 52 Long 2019, 8 Jancelewicz 2010 6 Four studies (132 patients total) that systematically reported death rates in treated patients were included in the table. Death rates for synthetic patches ranged from 19 to 32%, whereas...…”

“…Two studies were notable for reporting GOR outcomes for both synthetic and biological patches, rates of which were similar for both groups: Razumovskly et al demonstrated rates of 25% (from n ¼ 15) and 21% (from n ¼ 24) for synthetic and biological patches respectively, while Long et al demonstrated rates of 36% (from n ¼ 33) and 42% (from n ¼ 19) for synthetic and biological patches, respectively. 8,11 Three studies (107 patients) reporting chest wall deformity are presented, with the range of rates between 13 and 80% for synthetic patches only. The same three studies reporting scoliosis are also presented, with the range of rates between 6.1 and 40% for synthetic patches only.…”