Surgical management of the diaphragmatic defect in congenital diaphragmatic hernia: a contemporary review

被引:3
作者
Jank, Marietta [1 ,2 ,3 ]
Boettcher, Michael [3 ]
Keijzer, Richard [1 ,2 ]
机构
[1] Univ Manitoba, Childrens Hosp Res Inst Manitoba, Max Rady Coll Med, Rady Fac Heath Sci,Dept Surg,Div Pediat Surg, Winnipeg, MB, Canada
[2] Univ Manitoba, Childrens Hosp Res Inst Manitoba, Max Rady Coll Med, Rady Fac Hlth Sci,Dept Pediat & Child Hlth,Div Pe, Winnipeg, MB, Canada
[3] Heidelberg Univ, Univ Med Ctr Mannheim, Dept Pediat Surg, Mannheim, Germany
关键词
Congenital Abnormalities; Thoracic Surgery; MUSCLE FLAP REPAIR; REVERSE LATISSIMUS-DORSI; MINIMALLY INVASIVE REPAIR; THORACOSCOPIC REPAIR; PATCH REPAIR; ESOPHAGEAL ATRESIA; PROSTHETIC PATCH; EARLY RECURRENCE; MORGAGNI HERNIA; SYNTHETIC PATCH;
D O I
10.1136/wjps-2023-000747
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Worldwide, 150 children are born each day with congenital diaphragmatic hernia (CDH), a diaphragmatic defect with concomitant abnormal lung development. Patients with CDH with large defects are particularly challenging to treat, have the highest mortality, and are at significant risk of long-term complications. Advances in prenatal and neonatal treatments have improved survival in high-risk patients with CDH, but surgical treatment of large defects lacks standardization. Open repair by an abdominal approach has long been considered the traditional procedure, but the type of defect repair (patch or muscle flap) and patch material (non-absorbable, synthetic or absorbable, biological) remain subjects of debate. Increased experience and improved techniques in minimally invasive surgery (MIS) have expanded selection criteria for thoracoscopic defect repair in cardiopulmonary stable patients with small defects. However, the application of MIS to repair large defects remains controversial due to increased recurrence rates and unknown long-term effects of perioperative hypercapnia and acidosis resulting from capnothorax and reduced ventilation. Current recommendations on the surgical management rely on cohort studies of varying patient numbers and data on the long-term outcomes are sparse. Here, we discuss surgical approaches for diaphragmatic defect repair highlighting advancements, and knowledge gaps in surgical techniques (open surgery and MIS), patch materials and muscle flaps for large defects, as well as procedural adjuncts and management of CDH variants.
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页码:1 / 11
页数:11
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