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Prosthetic patch durability in congenital diaphragmatic hernia: a long-term follow-up study.

BACKGROUND/PURPOSE
The purpose of this study is to assess the durability of prosthetic patch repair of congenital diaphragmatic hernia (CDH) over time.


METHODS
The authors retrospectively reviewed the records of 109 children who had surgical repair of CDH between January 1989 and December 1996. Prosthetic patches were used for diaphragmatic agenesis or when the diaphragmatic defect was too large for primary closure after mobilizing the posterior leaf. Forty-five (41%) children required a prosthetic patch to repair the diaphragmatic defect, and 29 (64%) of these children survived.


RESULTS
Twelve (41%) of the 29 survivors required 1 or more operations for diaphragmatic reherniation. First-time reherniations occurred between 1 and 36 months postoperatively, median, 12 months. There was a bimodal distribution of first-time reherniations, with 4 children experiencing reherniation between 1 and 3 months, median age, 2 months and 8 children experiencing reherniation between 10 and 36 months, median age, 20 months. Three children returned for surgical repair of second reherniation between 21 and 39 months. Patients who had reherniation presented with bowel obstruction (n = 7), respiratory distress (n = 2), or were asymptomatic (n = 3). Revision of the reherniated patch consisted of placing an additional domed patch to fill the defect.


CONCLUSIONS
About half of all prosthetic patches used to repair CDH show evidence of reherniation and require revision within 3 years. Prosthetic patch repair is not a long-term solution for the child with CDH.