Low recurrence rate after Gore-Tex/Marlex composite patch repair for posterolateral congenital diaphragmatic hernia

Abstract Purpose Many different prosthetic materials have been used for repair of large posterolateral congenital diaphragmatic hernias (CDH), with high recurrence rates for hernias that cannot be primarily repaired. Since 1993, we have used a composite patch of Gore-Tex/Marlex to repair large CDHs...

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Bibliographic Details
Published in:Journal of pediatric surgery 2007-11, Vol.42 (11), p.1841-1844
Main Authors: Riehle, Kimberly J, Magnuson, David K, Waldhausen, John H.T
Format: Article
Language:English
Subjects:
Bockdalek hernia
Cohort Studies
Congenital diaphragmatic hernia
Female
Follow-Up Studies
Hernia, Diaphragmatic - genetics
Hernia, Diaphragmatic - mortality
Hernia, Diaphragmatic - pathology
Hernia, Diaphragmatic - surgery
Humans
Infant, Newborn
Laparotomy - methods
Male
Patch repair
Pediatrics
Polypropylenes
Polytetrafluoroethylene
Prosthesis Implantation - methods
Recurrence
Retrospective Studies
Risk Assessment
Severity of Illness Index
Surgery
Surgical Mesh
Survival Rate
Tensile Strength
Treatment Outcome
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Summary:Abstract Purpose Many different prosthetic materials have been used for repair of large posterolateral congenital diaphragmatic hernias (CDH), with high recurrence rates for hernias that cannot be primarily repaired. Since 1993, we have used a composite patch of Gore-Tex/Marlex to repair large CDHs and hypothesized that this repair leads to fewer recurrences. Methods This is a retrospective review of 137 consecutive patients with CDH cared for at a single institution from 1993 to 2004. Data collected include timing and method of repair and use of extracorporeal membrane oxygenation. Outcomes include hernia recurrence, complications, and death. Results One hundred thirty-seven patients with CDH were analyzed. Repair was not attempted in 12 because of disease severity. Primary repair was accomplished in 79 and 46 required patch repair. Of the 46 patients with patch repairs, 32 required extracorporeal membrane oxygenation, and 18 died before discharge. Of the 28 patch repair survivors, 1 (3.57%) developed a recurrence over a median follow-up of 47 months (range, 2-115 months). Overall survival was 77%. Conclusions Gore-Tex/Marlex composite patch repair of large CDHs in this complex patient population results in a lower recurrence rate than has been reported for other types of prosthetic diaphragm repair.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2007.07.009