Long-term outcomes after muscle flap repair in congenital diaphragmatic hernia: A retrospective study at a single institution

Abstract

Purpose: Infants with large congenital diaphragmatic hernia (CDH) defects pose a clinical challenge. Despite evidence that muscle flap repair (MFR) has lower recurrence rates than patch repair (PR), MFR remains uncommon and understudied. This study evaluated long-term outcomes in CDH patients who underwent MFR compared to PR at a single institution. We hypothesized that patients who underwent MFR have lower recurrence rates than patients who underwent PR.

Methods: Using an internal institutional registry, we identified all CDH patients who underwent repair between 1998 and 2024. Patients were stratified based on repair type, excluding primarily and non-repaired patients. Long-term follow-up was obtained through our institutional pulmonary hypoplasia clinic and retrospective chart review, with supplementary phone calls made to patients who were lost to follow-up. Our primary outcome was CDH recurrence and secondarily wound infection, small bowel obstruction (SBO), abdominal wall hernia, scoliosis and pectus excavatum. Analysis was done using bivariate comparisons.

Results: A retrospective cohort of 456 patients with CDH from 1998 to 2024 was identified. 71 patients were not repaired, and 246 underwent primary repair. The remaining 139 patients underwent complex repair: 108 MFR and 31 PR. 32 did not survive after repair to discharge from NICU (19 MFR and 13 PR). 12 patients were lost to follow-up and we have reliable long-term follow-up in 95 patients. Of these, there are 80 MFR and 15 PR. The median follow-up time was 5 years [IQR 3-11]. Demographics were similar across cohorts. In the MFR group, 5/80 (6.3 %) had a recurrence compared to 7/15 (46.7 %) in the patch group (p=<0.001). PR had a significantly higher rate of infection than MFR. SBO and hernia rates were similar across groups. Scoliosis and chest wall deformity rates were similar, with five patients requiring operative intervention for scoliosis and one requiring minimally invasive repair of pectus excavatum.

Conclusion: MFR is a viable treatment option for large CDH defects and has a lower recurrence rate than PR. In this long-term follow-up study, MFR did not result in a higher rate of infection, bowel obstruction, hernia, chest wall deformity, or scoliosis.

Level of evidence: IV.

Keywords: Congenital diaphragmatic hernia; Muscle flap repair; Pediatric surgery.