Low recurrence rate after Gore-Tex/Marlex composite patch repair for posterolateral congenital diaphragmatic hernia

Congenital Diaphragmatic Hernia: State of the Art Reconstruction- Biologics Versus Synthetics

“…Biologics ideally, with tissue incorporation, would be able to avoid the reherniation rates characteristic of prosthetic patches and the scoliosis from the inability of a prosthetic to compensate for age-related growth of the thoracic cavity. The most commonly used acellular bioprosthetic patches include SurgisisGold (Cook Biotech, Lafayette, IN), Permacol (Tissue Science Laboratories Inc, Andover, Mass), Alloderm (LifeCell Inc, Branchburg, NJ), or recent composites with a synthetic sandwiched as an overlay to a bioprosthetic, such as Gore-tex® and Surgisis®(See Figure 1D) Prior bilayer patches incorporated both Gore-tex® and Marlex® which demonstrated only one recurrence (3.5%) (Riehle et al, 2007) which suggested a benefit of sandwiching a synthetic with a monofilament mesh to induce tissue incorporation. Synthetic patch repairs emerged historically as the predominant method of tension-free closure of defects not amenable to primary repair (Levison et al, 2006).…”

“…Composite patch repairs, such as Gore-Tex®/Marlex synthetic patches, have been reported used in humans with only a 3% recurrence rate, followed for a median of 47 months, but had an unusual comorbidity of a 17% splenectomy rate which is nontrivial in this population (Riehle et al, 2007). The search for an ideal material for CDH repairs is an ongoing active area of investigation.…”

Surgical Management of the Newborn with Congenital Diaphragmatic Hernia

“…As a result, the recurrence rate decreased from 46 to 9% in the first year after repair. Riehle et al [74] described using a double-sided patch of Gore-Tex and Marlex with minimal recurrences.…”

“…Non-absorbable patches that are anchored to the chest wall produce a tethering point and may contribute to pectus-type deformities [75,76] . Others have described increased incidences of bowel obstructions, need for splenectomy, patch infections, and abdominal wall deformities [67,71,74,77] .…”

Heparinized collagen scaffolds with and without growth factors for the repair of diaphragmatic hernia

“…Patch materials commonly applied include polytetrafluoroethylene (PTFE) 1 and small intestinal submucosa (SIS), derived from decellularised porcine submucosa. 2 Both types of materials have been found successful in some studies, [3][4][5] but showed high recurrence rates in others. 2,6,7 A recent meta-analysis reported no differences between PTFE and SIS, both materials having a recurrence rate of over 30%.…”