Recurrence of Diaphragmatic Hernia After Thoracoscopic Repair With Strattice Patch
Hanna Alemayehu, MD, Samir Pandya, MD, Whitney McBride, MD, Gustavo Stringel, MD
Department of Surgery, Westchester Medical Center, Valhalla, NY, USA (Dr. Alemayehu). Department of Pediatric Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY (Drs. Pandya, McBride, Stringel).
Introduction: Thoracoscopic repair of congenital diaphragmatic hernia has increased with the use of prosthetic material. When the defect cannot be repaired primarily, a variety of materials have been used. The ideal prosthetic material has not been identified yet. The use of biologic tissue matrix prosthesis is appealing because this material may serve as a framework to support the patient’s own tissue regeneration. We report on 2 newborns with congenital diaphragmatic hernia repaired by thoracoscopy with placement of a Strattice patch (LifeCell, Branchburg, New Jersey). The hernia recurred in both cases.
Case Description: Two neonates born at term, weighing 3.5 kg and 4.0 kg, had left-sided congenital diaphragmatic hernias repaired by thoracoscopy with a Strattice patch. The repairs were performed at 1 and 4 days of age after a period of stabilization. There were no other congenital anomalies. There were no operative complications. The neonates recovered uneventfully and were discharged in good condition. Recurrence of the diaphragmatic hernia was identified by chest radiographs at routine follow-up visits 16 and 22 months postoperatively. One patient had mild abdominal pain and increasing shortness of breath, whereas the other patient was asymptomatic. One patient had an abdominal open primary repair of the recurrent diaphragmatic hernia, whereas the other patient had a laparoscopy-assisted repair with AlloDerm patch (LifeCell). They both recovered uneventfully.
Discussion: Postoperative follow-up at regular intervals is extremely important after repair of diaphragmatic hernia, especially when prosthetic material is used, because of the high incidence of recurrence. We do not recommend the repair of diaphragmatic hernia with the Strattice patch at this time.
Key Words: Congenital diaphragmatic hernia repair, Thoracoscopy, Strattice mesh