Recurrence of Congenital Diaphragmatic Hernia: Risk Factors, Management, and Future Perspectives.

Francesco Macchini,Genny Raffaeli,Ilaria Amodeo,Lucas Wessel,Giacomo Cavallaro,Martina Ichino,José Luis Encinas,Leopoldo Martinez

doi:10.3389/fped.2022.823180

Abstract

Recurrence is one of the most common surgical complications in Congenital Diaphragmatic Hernia (CDH). It could remain clinically silent for a long time or present as an acute complication week, months, or even years after the primary surgery. Several risk factors have been identified so far. An extended diaphragmatic defect represents one of the leading independent risk factors, together with indirect signs of large defect such as the liver position related to the diaphragm and the use of the prosthetic patch and with the use of a minimally invasive surgical (MIS) approach. However, the exact contribution of each factor and the overall risk of recurrence during the life span still need to be fully understood. This mini-review aims to give an overview of the current knowledge regarding CDH recurrence, focusing on predisposing factors, clinical presentation, management and follow-up of high-risk patients, and future perspectives.

Highlights

Recurrence of Congenital Diaphragmatic Hernia (CDH) represents a common complication in CDH survivors, along with pulmonary, gastrointestinal, neurobehavioral, and developmental anomalies [1–4]
The unit increase in total and ipsilateral area in cm2 was associated with a 14 and 29% reduction in the risk of recurrence, respectively [17]. These findings further suggest that recurrence is related to the defect size
The PTFE appears to be associated with a low recurrence rate and is recommended by international groups [10, 57]

Summary

INTRODUCTION

Recurrence of Congenital Diaphragmatic Hernia (CDH) represents a common complication in CDH survivors, along with pulmonary, gastrointestinal, neurobehavioral, and developmental anomalies [1–4]. It mostly happens at the site of the original hernia, but occasionally hiatal hernia may follow CDH repair due to tension on the diaphragmatic crura. The incidence of recurrence after CDH repair varies considerably, ranging from 5 to 65% in reports with different lengths of follow-up and different follow-up protocols [4–11]. The average age at recurrence is 12 months, with 47.6% of cases occurring before 1 year of age, 76.2% before 2 years, and near 100% before 5 years [12–14]. 3% of cases are reported as an early in-hospital recurrence [2].

PREDISPOSING FACTORS

CONCLUSIONS AND FUTURE PERSPECTIVES

Findings

AUTHOR CONTRIBUTIONS