A systematic review and meta-analysis of surgical morbidity of primary versus patch repaired congenital diaphragmatic hernia patients

Abstract

Large studies comparing the surgical outcome of primary versus patch repair in congenital diaphragmatic hernia (CDH) patients are rare. This study aims to evaluate the incidence of surgical complications in both types of CDH repair. PubMed, EMBASE, Cochrane and Web of Science were searched for peer-reviewed articles. Studies on CDH between 1991 and August 2020 were systematically screened and meta-analyses were performed. Primary outcomes of this review were: haemorrhage, chylothorax, recurrences and small bowel obstruction (SBO). A total of 6436 abstracts were screened, after which 25 publications were included (2910 patients). Patch repaired patients have a 2.8 times higher risk on developing a recurrence (20 studies) and a 2.5 times higher risk on developing a chylothorax (five studies). Moreover, they have a two times higher risk on developing a SBO. No studies could be included that evaluated the incidence of surgical haemorrhage between these patients. Although the quality of the studies was relatively low, patch repaired patients have a higher risk on developing a recurrence, chylothorax and small bowel obstruction. Large prospective studies are required to adjust for severity of disease, to reveal the true causative factors in order to minimize the risk on these surgical complications in both types of patients.

Longitudinal Follow-Up With Radiologic Screening for Recurrence and Secondary Hiatal Hernia in Neonates With Open Repair of Congenital Diaphragmatic Hernia—A Large Prospective, Observational Cohort Study at One Referral Center

“…A higher recurrence rate after patch implantation in OS of more than 40% has been observed by several authors (26,33,51,52). In a review on morbidity after CDH repair, the risk of recurrence was reported to be 3.6 times higher after open patch repair (53). Only Riehle reported a low recurrence rate of 4% in 28 patients with an oversize patch in a retrospective study with no structured follow-up (25).…”

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

“…Despite this, the use of patches for repair has been increasing in the last decade. Patients who require a diaphragmatic patch repair are reported to have a risk 2.83 times higher of developing a recurrence ( 26 ). The inability of the synthetic patch to grow with the patient is the mechanism underlying this strong association ( 2 ).…”

“…The inability of the synthetic patch to grow with the patient is the mechanism underlying this strong association ( 2 ). But, again, the disease's severity and the defect's size may present an underlying independent role ( 26 ). The goal of the patch is to allow closure of the defect without tension on the surrounding structures, despite a large defect size, granting a tension-free suture.…”

“…Based on current evidence, major international study groups recommend using non-absorbable prosthetic patches, mainly PTFE, aiming at an oversized/dome shape. PTFE appears safe and is associated with a low recurrence rate ( 7 , 10 , 26 , 37 ).…”

“…Moreover, it provides additional abdominal volume during the significant growth of the first year of life, facilitating tissue ingrowth coming from folds of the redundant material sutured to the rims of the diaphragm (28). Nonetheless, some single-center studies do not report any significant difference in hernia recurrence rates between the patch and primary repair, while other authors even described a reduced recurrence rate in patients treated with a patch (6,27,29,30), in contrast with data of large series from high-volume centers (6,16,26).…”