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Acta Medica Medianae
Vol. 53, No 4, Decembar, 2014

UDC 61
ISSN 0365-4478(Printed version)
ISSN 1821-2794(Online)


Correspondence to:


Prof. Amulya K. Saxena, MD, PhD, FRCS

Department of Pediatric Surgery

Chelsea and Westminster Hospital NHS Fdn Trust

Imperial College London

369 Fulham Road, London, SW10 9NH, United Kingdom

Email: amulya.saxena@nhs.net

Case report                                                                                   UDC: 616.26-007.43-053.2                                                                                                             doi:10.5633/amm.2014.0408



Dome-shaped patch offers optimal biomechanics for repair of large defects in congenital diaphragmatic hernia


Amulya K. Saxena



Department of Pediatric Surgery, Chelsea and Westminster Hospital, Imperial College London, United Kingdom


The surgical management of congenital diaphragmatic hernia (CDH) using biomaterials is still not clearly understood.  A neonate with a large left-sided CDH and severe pulmonary hypoplasia was offered surgical closure of the defect using a polytetrafluoroethylene (PTFE) patch on the 12th day after birth. The infant presented with a recurrence 2.5 months later as an emergency with intestinal herniation in the thorax manifesting in the form of a mechanical ileus. The recurrence was managed using a cone-shaped PTFE patch with tension-free approximation to the residual diaphragm and ribs. Six months after the second repair, the infant presented a second recurrence detected during a regular follow-up examination. The second recurrence was managed with a dome-shaped PTFE and polypropylene (PP) patch (composite prosthetic) which offered the advantage of providing a larger volume for the accommodation of the intestinal viscera. The follow-up examinations over the past 12 months have been uneventful. Acta Medica Medianae 2014;53(4):42-45.


Key words: congenital diaphragmatic hernia, recurrence, dome-shaped patch, polytetrafluoroethylene, polypropylene