Our Summary

This research paper looks at two methods of repairing a certain type of hernia in babies called congenital diaphragmatic hernia (CDH). The two methods are: using a prosthetic patch, or using muscle flaps. The study was particularly interested in those surgeries that were performed while the baby was on a special life-support machine called ECMO. The researchers believed that using muscle flaps might result in less bleeding than using a patch because the body’s own tissue helps to stop bleeding.

The study looked back at patients who had this type of surgery while on ECMO between 2008 and 2022. Out of 52 patients, 18 had patch repairs and 34 had muscle flap repairs. The severity of the hernias was similar in both groups.

The results showed that less patients needed another operation for bleeding after muscle flap repair compared to patch repair. Also, less blood was needed for transfusion after muscle flap repair and more patients survived up to two years after muscle flap repair.

Even after considering factors like which side the hernia was on, how long the baby was on ECMO, and the age of the baby at the time of repair, muscle flap repair was still associated with less blood transfusion, more babies surviving until they left the hospital, and more babies surviving up to two years.

So, the study concluded that muscle flap repair seems to have less bleeding complications than patch repair, which could be one of the reasons why more babies survive. Therefore, the study supports the use of muscle flap repair for this type of hernia when the baby is on ECMO.

FAQs

  1. What are the two techniques used for the repair of congenital diaphragmatic hernia (CDH) with a large defect?
  2. Between the prosthetic patch and muscle flap techniques, which one is associated with fewer bleeding complications in on-ECMO CDH repair?
  3. Does the muscle flap technique affect the survival rate of patients with CDH undergoing on-ECMO CDH repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to consider the muscle flap technique as it may be associated with reduced bleeding complications compared to prosthetic patch repair. This could potentially lead to improved survival outcomes. It is important to discuss with your surgeon which technique may be best for your specific case.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) with a large defect unamenable to primary closure are typically recommended for repair using prosthetic patches or muscle flaps. In particular, patients who require repair while on extra-corporeal membrane oxygenation (ECMO) may benefit from the muscle flap technique due to decreased bleeding complications compared to patch repair. This technique may be especially beneficial for patients with severe CDH, as it has been associated with lower reoperation rates for surgical bleeding, reduced postoperative blood product transfusion requirements, and improved survival outcomes. Overall, the muscle flap technique is considered a favored method for CDH repair in patients on ECMO.

Timeline

Before congenital diaphragmatic hernia repair:

  • Patient is diagnosed with congenital diaphragmatic hernia (CDH) through prenatal ultrasound or after birth
  • Patient may undergo stabilization and treatment in the neonatal intensive care unit (NICU)
  • Patient may be placed on extra-corporeal membrane oxygenation (ECMO) for respiratory support
  • Surgical team evaluates the CDH defect size and determines the best repair technique

After congenital diaphragmatic hernia repair:

  • Patient undergoes CDH repair surgery while on ECMO, either using a prosthetic patch or muscle flap technique
  • Postoperatively, patient is monitored for bleeding complications and may require blood product transfusions
  • Patient’s recovery and prognosis are closely monitored, with long-term survival rates assessed
  • Follow-up care includes monitoring for potential complications such as recurrence of CDH or respiratory issues, and ongoing support for the patient and family.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with congenital diaphragmatic hernia repair surgery?
  2. How do the muscle flap and prosthetic patch techniques differ in terms of outcomes and recovery?
  3. Why might the muscle flap technique be preferred for CDH repair while on extra-corporeal membrane oxygenation (ECMO)?
  4. What is the expected recovery time and rehabilitation process following CDH repair surgery?
  5. Are there any long-term effects or considerations to keep in mind after undergoing CDH repair surgery?
  6. What follow-up care and monitoring will be necessary after the surgery?
  7. How does the surgeon determine which repair technique is most appropriate for each individual patient?
  8. What is the success rate and expected outcomes for CDH repair surgery in general?
  9. Are there any specific lifestyle changes or precautions that should be taken after CDH repair surgery?
  10. Are there any alternative treatment options or procedures available for CDH repair?

Reference

Authors: Vaughn AE, Lyttle BD, Louiselle AE, Cooper E, Niemiec SM, Phillips R, Hilton SA, Kinsella JP, Gien J, Derderian SC, Liechty KW. Journal: J Pediatr Surg. 2024 May;59(5):962-968. doi: 10.1016/j.jpedsurg.2023.11.022. Epub 2023 Dec 8. PMID: 38160185