APSA Paper
Prosthetic patches for congenital diaphragmatic hernia repair: Surgisis vs Gore-Tex

https://doi.org/10.1016/j.jpedsurg.2005.10.005Get rights and content

Abstract

Purpose

The sequelae of congenital diaphragmatic hernia (CDH) continue well beyond the perinatal period. Up to 50% of these patients have subsequent recurrent herniation or small bowel obstruction (SBO). A recent trend has been toward the use of bioactive prosthetic materials. We reviewed different patch closure techniques used for CDH repair at our institution and their association with these sequelae.

Methods

A retrospective review was performed of 152 records for patients with CDH. Newborns that underwent patch repair for CDH and survived for at least 30 days were included in the analysis. Primary outcomes evaluated were recurrent herniation and SBO. Two types of prostheses were examined, Gore-Tex, an artificial material, and Surgisis, a bioactive material.

Results

Twelve (44%) of 27 patients who had Surgisis repair had recurrent herniation. Seventeen (38%) of 45 patients who had a Gore-Tex repair had recurrent herniation. Two additional patients in each group presented with SBO. No significant difference in recurrent herniation rates was observed (P > .5). The time to recurrence was similar in both groups (log-rank, P = .75), with most recurrences (92% Surgisis, 76% Gore-Tex) occurring in the first year.

Conclusion

The rates of recurrent herniation and SBO after neonatal prosthetic patch repair of CDH were similar regardless of the prosthetic material used (Surgisis or Gore-Tex).

Section snippets

Methods

Institutional approval was obtained by the Committee for Human Research. We retrospectively reviewed the medical records of 152 infants with CDH treated between February 1993 and May 2004 at the University of California, San Francisco. We identified 130 children who underwent at least one neonatal repair of CDH by computerized search. Seventy-two newborns underwent prosthetic patch repair for CDH with either Gore-Tex (GTX) or Surgisis (SIS) (Cook Surgical, Bloomington, Ind) prostheses and

Results

Of the 72 newborns that underwent patch repair, 45 had patch repair with GTX and 27 had patch repair with SIS. At the time of surgery, a similar incidence of diaphragmatic aplasia was noted (7 and 5 cases, respectively, for GTX and SIS; Table 1). The GTX group and the SIS group were not different with respect to the antenatal ultrasound predictor, the lung-head ratio [8], [9], or need for extracorporeal membrane oxygenation (ECMO) support. The GTX group had a significantly longer duration of

Discussion

With the advent of increasingly successful perinatal therapies for infants with severe CDH, a new cohort of patients has been increasingly recognized, with the realization that the initial repair might not be sufficient as the child grows. Before 1990, there were very few reports of recurrences; however, over the past decade, this morbidity has been revealed. Reports in the literature vary widely as to the rate of recurrent herniation, from 5% to 60% [1], [10]. Certain risk factors have been

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    • Cited by (0)

    Presented at the 36th Annual Meeting of the American Pediatric Surgical Association, Phoenix, AZ, May 29-June 1,2005.

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