P241: Abdominal complications related to type of repair for congentital diaphragmatic hernia

Abstract

Introduction: Literature on congenital diaphragmatic hernia (CDH) over the past few decades has focused on prognostic factors and management of pulmonary hypertension/hypoplasia. Larger diaphragmatic defects may require patch closure, reported by some authors to be associated with poorer outcomes. In this study, we evaluate the impact synthetic material has on the need for subsequent abdominal operations, particularly recurrence and small bowel obstruction (SBO). Methods: After obtaining IRB approval, all patients undergoing repair of congenital diaphragmatic from January, 1994 to December, 2004 were investigated. Records from primary and subsequent admissions were reviewed to identify those patients who underwent major procedures after repair of the diaphragmatic defect. Subsequent abdominal operations in theis series were recurrent CDH repair, exploration for SBO and fundoplication. Patients who expired within the first year of life were excluded. Statistical comparisons were made using Fisher’s exact test: significance was defined as P < 0.05. Results: During the study period, there were 81 survivors from CDH repair, 24 with a synthetic patch, and 57 without. Those with a patch repair had a significantly increased risk of recurrence, small bowel obstruction and subsequent operation (Table 1). Eleven patients had non-absorbable mesh patches, and 13 were repaired with absorbable (Surgisis® - Gold™). While there were no differences in recurrence between these two groups, 4 patients (31%) with Surgisis® developed SBO compared to 1 patient (9%) repaired with a non-absorbable synthetic. Conclusions: Incidence of SBO and recurrent CDH in patients with a patch was higher than those who underwent primary repair. There may also be a difference in the rate of subsequent SBO depending on the type of mesh used. A prospective trial is underway at our institution to help define this issue. Table 1 Primary Closure (N=57) Patch Repair (N=24) P-Value Small Bowel Obstruction 3 (5%) 5 (21%) 0.046 Recurrence 4 (7%) 6 (25%) 0.020 Fundoplication 6 (11%) 5 (21%) 0.29 Subsequent abdominal operation 10 (18%) 15 (63%) < 0.001 Open table in a new tab