Eur J Pediatr Surg
DOI: 10.1055/s-0039-1687867
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Outcomes after Split Abdominal Wall Muscle Flap Repair for Large Congenital Diaphragmatic Hernias

1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
Laura García Martínez
1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
Gabriela Guillén Burrieza
1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
José Luís Peiró Ibáñez
2  Division of Pediatric General and Thoracic Surgical, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Sergio López-Fernández
1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
Ana Laín
1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
Cesar Ruiz Campillo
1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
Josep Lloret Roca
1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
,
Manuel López
1  Department of Pediatric Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

13 December 2018

09 March 2019

Publication Date:
25 April 2019 (eFirst)

Abstract

Background Repair of large congenital diaphragmatic hernias (CDHs) is challenging. As primary repair is not always feasible, patches are commonly used. An alternative treatment is split abdominal wall muscle flap repair, which uses vascularized autologous tissue. The aim of this study was to analyze the long-term outcome of large CDH defects undergoing split abdominal wall muscle repair.

Materials and Methods This is a retrospective review (2003–2016) of large CDH treated by split abdominal wall muscle flap repair.

Results In a total of 107 CDH patients, the abdominal muscle flap technique was used in 10 (9.3%); 7 had been prenatally treated with tracheal occlusion. Two patients experienced recurrence at 2 months and 6 years, respectively. Only one patient required abdominoplasty due to abdominal wall muscle weakness. Two patients developed progressive scoliosis; one of them required orthopaedic treatment. Minor chest wall deformities were detected in seven, but only one required orthopaedic treatment. The lung-to-head ratio was 0.79 in patients developing musculoskeletal deformities, and 1.5 in those without this complication (p < 0.05). Median follow-up was 11.2 years (3.5–14.2), and all patients were alive at the time of writing this article.

Conclusion The split abdominal wall muscle flap technique is a valid option for repair of large CDH. Associated musculoskeletal deformities seem to be influenced not only by the repair technique used but also by the degree of pulmonary hypoplasia and inherent pathophysiological changes.