Results of diaphragm agenesis repair
DOI:
https://doi.org/10.15574/SP.2024.7(143).4652Keywords:
congenital diaphragmatic hernia, diaphragm agenesis, recurrence, thoracalization, polytetrafluoroethyleneAbstract
Aim: assessment of short-term outcomes in children after diaphragmatic agenesis repair and selection of the optimal method for defect repair.
Materials and methods. This study involved 10 newborns with congenital diaphragmatic hernia (type D) who underwent surgery in one hospital between 2000 and 2023, followed by an assessment of complications, mortality, and the effectiveness of the thoracalization concept of the abdominal cavity.
Results. There were 6 (60%) male patients and 4 (40%) female patients. Right-sided diaphragmatic dome agenesis was diagnosed in 2 (20%) children and left-sided in 8 (80%). Early total mortality in this group was 60%. The surgical approach for treatment was thoracotomy in 80% (n=8) of cases, and in 2 (20%) cases transverse subcostal laparotomy was chosen. All diaphragmatic agenesis repairs were performed using patches (mostly made of polytetrafluoroethylene), with 8 of them applying the principle of thoracalization of the abdominal cavity. Indications for reoperations in our group included hernia recurrence - 2 cases (in one patient at 6 and 15 months) and intestinal obstruction caused by malrotation - 1 case.
Conclusions. Patients with diaphragmatic agenesis have higher mortality compared to the group with small and medium defects. The size of the diaphragmatic defect is an independent prognostic factor and may serve as a marker for the degree of pulmonary hypoplasia and pulmonary hypertension. The optimal method of surgical treatment is diaphragmatic repair using a synthetic polytetrafluoroethylene patch with thoracalization of the abdominal cavity.
The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethical Committee of these institutions. The informed consent of the children's parents was obtained for the research.
No conflict of interests was declared by the authors.
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