Does creating a dome reduce recurrence in congenital diaphragmatic hernia following patch repair?

Autor: Verla MA; Texas Children's Fetal Center, Houston, TX, USA; Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Style CC; Center for Regenerative Medicine, Nationwide Children's Hospital, 575 Children's Drive, Columbus, OH 43205, USA. Electronic address: candace.style@nationwidechildrens.org., Lee TC; Texas Children's Fetal Center, Houston, TX, USA; Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Menchaca AD; Center for Regenerative Medicine, Nationwide Children's Hospital, 575 Children's Drive, Columbus, OH 43205, USA., Lau PE; Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Mehollin-Ray AR; Texas Children's Fetal Center, Houston, TX, USA; Texas Children's Hospital, Department of Radiology, Baylor College of Medicine, Houston, TX, USA., Fernandes CJ; Texas Children's Fetal Center, Houston, TX, USA; Texas Children's Hospital, Department of Pediatrics - Newbowrn Section, Baylor College of Medicine, Houston, TX, USA., Keswani SG; Texas Children's Fetal Center, Houston, TX, USA; Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Olutoye OO; Center for Regenerative Medicine, Nationwide Children's Hospital, 575 Children's Drive, Columbus, OH 43205, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2022 Apr; Vol. 57 (4), pp. 637-642. Date of Electronic Publication: 2021 Oct 22.
DOI: 10.1016/j.jpedsurg.2021.10.014
Abstrakt: Purpose: To develop a quantifiable approach to identify a dome shape of the repaired diaphragm using post-operative chest radiograph and to determine if a dome-shaped prosthetic patch repair is associated with a decreased rate of CDH recurrence.
Methods: We conducted a retrospective review of all neonates evaluated at our institution from January 2004 to August 2017 with left- and right-sided CDH with at least 6 months of follow-up after CDH repair. Patch use, post-operative imaging and postnatal outcomes were analyzed. Neonates with patch repair were divided into two groups based on the presence of a dome. Using postoperative chest radiographs, the presence of a dome was classified as having a vertical-horizontal diaphragm ratio (VHDR) greater than 20%. Primary outcome was CDH recurrence after repair.
Results: We identified 192 neonates who met our inclusion criteria. Cohort survival was 96%, recurrence rate was 15%, 78% had a left-sided CDH; 54% received a patch repair, of which 58% had a type C defect. Of the 104 infants with patch repairs, the CDH recurrence rate was 22% (n = 23) at a median age of 8.5 months (3.8, 20.1). Although neonates with a dome repair had more ECMO use and longer hospital stay, their recurrence rate was about half of those with a non-dome repair (14% vs 28%, p = 0.07).
Conclusions: A dome-shaped repair may reduce recurrence following prosthetic patch repair of congenital diaphragmatic hernia. A larger, multi-institutional study is needed to statistically validate this clinically significant observation.
Type of Study: Retrospective review.
Level of Evidence: III.
(Copyright © 2021. Published by Elsevier Inc.)
Databáze: MEDLINE
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