Use of composite polyester/collagen mesh in the repair of recurrent congenital diaphragmatic hernias

Abstract

Abstract Case 1 is an 18 year-old woman with a third recurrence of a left congenital diaphragmatic hernia (CDH). She had previously undergone a primary repair of a recurrence via laparotomy and an additional repair of a second recurrence with PTFE mesh via a thoracotomy. Following her third recurrence she underwent successful laparoscopic repair utilizing composite polyester/collagen (Parietex™ Composite, Covidien, Sofradim, France) mesh. Six years following surgery, she has carried a pregnancy to term and has not recurred. Case 2 is a 5 month-old infant who presented with a recurrent right-sided CDH. She initially underwent primary repair via thoracotomy along with a right pneumonectomy at an outside institution. She presented with incarceration of her liver, hepatic venous thrombosis, mediastinal shift, and respiratory distress. She underwent successful repair with composite mesh through a right thoracoabdominal incision. At 8 months post-operatively, she has no evidence of recurrence in spite of the expected mediastinal deviation to the right and right thoracic volume loss as a result of being status post right pneumonectomy. Recurrences occur in a significant number of patients following repair of congenital diaphragmatic hernia, particularly cases in which a mesh implant are utilized. Historically, PTFE has been the product of choice for a diaphragmatic implant by pediatric surgeons. However, this product does not incorporate into surrounding tissues which theoretically places patients at risk for recurrence. Polyester/collagen composite mesh has been used for decades in adults undergoing complex groin and ventral hernia repairs with excellent results. However, its use for congenital diaphragmatic hernias has not been previously described. We present the successful utilization of this product in two cases which were at extremely high risk for future recurrence. Additional investigations should be done and long term follow up regarding application of this product for this challenging clinical condition.