Abdominal wall muscle weakness outcomes after split abdominal flap repair of large congenital diaphragmatic hernias in newborn

• Published in: Pediatric surgery international 2024-07, Vol.40 (1), p.171, Article 171
• Main Authors: Molino, J. Andrés, Guillen, Gabriela, Khan, Haider Ali, López Fernández, Sergio, Martos Rodríguez, Marta, Rocha, Oscar, López Paredes, Manuel
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Muscles - surgery; Abdominal Wall - surgery; Female; Hernias, Diaphragmatic, Congenital - complications; Hernias, Diaphragmatic, Congenital - surgery; Herniorrhaphy - methods; Humans; Infant, Newborn; Male; Medicine; Medicine & Public Health; Muscle Weakness - etiology; Muscle Weakness - surgery; Original Article; Pediatric Surgery; Pediatrics; Postoperative Complications - surgery; Retrospective Studies; Surgery; Surgical Flaps; Treatment Outcome
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-024-05751-8

Purpose Split abdominal wall muscle flap (SAWMF) is a technique to repair large defects in congenital diaphragmatic hernia (CDH). A possible objection to this intervention could be any associated abdominal muscle weakness. Our aim is to analyze the evolution of this abdominal muscle wall weakness. Methods Retrospective review of CDH repair by SAWMF (internal oblique muscle and transverse) from 2004 to 2023 focusing on the evolution of muscle wall weakness. Results Eighteen neonates of 148 CDH patients (12,1%) were repaired using SAWMF. Mean gestational age and birth weight were 35.7 ± 3.5 weeks and 2587 ± 816 g. Mean lung-to-head ratio was 1.49 ± 0.28 and 78% liver-up. Seven patients (38%) were prenatally treated by tracheal occlusion. Ninety-four percent of the flaps were used for primary repair and one to repair a recurrence. One patient (5.6%) experienced recurrence. Abdominal muscle wall weakness was present in the form of a bulge. Resolution of weakness at 1, 2 and 3 years was 67%, 89% and 94%, respectively. No patient required treatment for weakness or died. Conclusions Abdominal muscular weakness after a split abdominal wall muscle flap repair is not a limitation for its realization since it is asymptomatic and presents a prompt spontaneous resolution. Level of evidence IV.