What is the best prosthetic material for patch repair of congenital diaphragmatic hernia? Comparison and meta-analysis of porcine small intestinal submucosa and polytetrafluoroethylene

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

“…The supportive literature for patch use in CDH consists of cohort studies of low quality. 55,56,[60][61][62] We endorse the use of tension-free or cone-shaped polytetrafluorethylene/ GORE-TEX patches, because of the accumulated experience with their use. We specifically advocate against the use of intestinal submucosal patches alone, as they are associated with an unacceptably high rate of recurrence.…”

Current Concepts in the Management of Congenital Diaphragmatic Hernia in Infants

“…Approximately half of all the repairs that require some type of patch may result in recurrent diaphragmatic herniation. A recent meta-analysis comparing the use of Gore-Tex and Surgisis in infants with CDH patch repair showed no differences between the two prosthetic materials in the incidence of hernia recurrence and small bowel obstruction rate [40]. The use of minimally invasive surgery techniques for repair of CDH is gaining popularity; however, they have a significantly higher recurrence risk of herniation [41].…”

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

“…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%. 7 In case of PTFE patches this may be due to the lack of growth of the material with the child 8 and limited cellular infiltration.…”

“…2,6,7 A recent meta-analysis reported no differences between PTFE and SIS, both materials having a recurrence rate of over 30%. 7 In case of PTFE patches this may be due to the lack of growth of the material with the child 8 and limited cellular infiltration. 9 With regard to cellular ingrowth the diaphragm A regenerative medicine approach to restore the morphology and function of the diaphragm in congenital diaphragmatic hernia is especially challenging because of the position and flat nature of this organ, allowing cell ingrowth primarily from the perimeter.…”

“…2 Moreover, it has been suggested that SIS is degraded too fast as the manufacturer indicated resorption of the material in 2 weeks. 7 In a previous study, 10 we have therefore used porous type I collagen bioscaffolds, strengthened by crosslinking, to close surgically created diaphragmatic defects in rats. Scaffold degradation and deposition of new collagen and of mesothelium were observed, and reherniations did not occur.…”