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 12^th 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