Patches in Congenital Diaphragmatic Hernia Systematic Review

Objective: This systematic review aims to evaluate current choices in practice and outcomes of biomaterials used in patch repair of congenital diaphragmatic hernia (CDH). Background: Multiple biomaterials, both novel and combinations of pre-existing materials are employed in patch repair of large size CDHs. Methods: A literature search was performed across Embase, Medline, Scopus, and Web of Science. Publications that explicitly reported patch repair, material used, and recurrences following CDH repair were selected. Results: Sixty-three papers were included, presenting data on 4595 patients, of which 1803 (39.2%) were managed using 19 types of patches. Goretex (R) (GTX) (n=1106) was the most frequently employed patch followed by Dualmesh (R) (n=267), Surgisis (R) (n=156), Marlex (R)/GTX (R) (n=56), Tutoplast dura (R) (n=40), Dacron (R) (n=34), Dacron (R)/GTX (R) (n=32), Permacol (R) (n=24), Teflon (R) (n=24), Surgisis (R)/GTX (R) (n=15), Sauvage (R) Filamentous Fabric (n=13), Marlex (R) (n=9), Alloderm (R) (n=8), Silastic (R) (n=4), Collagen coated Vicryl (R) mesh (CCVM) (n=1), Mersilene (R) (n=1), and MatriStem (R) (n=1) Biomaterials were further subgrouped as: synthetic nonresorbable (SNOR) (n=1458), natural resorbable (NR) (n=241), combined natural and synthetic nonresorbable (NSNOR) (n=103), and combined natural and synthetic resorbable (NSR) (n=1). The overall recurrence rate for patch repair was 16.6% (n=299). For patch types with n>20, recurrence rate was lowest in GTX/Marlex (3.6%), followed by Teflon (4.2%), Dacron (5.6%), Dualmesh (12.4%), GTX (14.8%), Permacol (16.0%), Tutoplast Dura (17.5%), SIS/GTX (26.7%), SIS (34.6%), and Dacron/GTX (37.5%).When analyzed by biomaterial groups, recurrence was highest in NSR (100%), followed by NR (31.5%), NSNOR (17.5%), and SNOR the least (14.0%) Conclusion: In this cohort, over one-third of CDH were closed using patches. To date, 19 patch types/variations have been employed for CDH closure. GTX is the most popular, employed in over 60% of patients; however, excluding smaller cohorts (n<20), GTX/Marlex is associated with the lowest recurrence rate (3.6%). SNOR was the material type least associated with recurrence, while NSR experienced recurrence in every instance.