A differentiated approach to the repair of diaphragmatic defects of varying sizes in neonates with congenital diaphragmatic hernia
DOI:
https://doi.org/10.15574/PS.2026.1(90).3342Keywords:
congenital malformation, congenital diaphragmatic hernia, diaphragmatic defect, defect size, surgical repair, muscle flap, prognosis, neonatesAbstract
The lack of clear algorithms for a differentiated approach to diaphragmatic defect repair leads to variability in surgical decision-making and complicates the comparison of treatment outcomes across pediatric surgery centers.
Aim – to develop a differentiated approach to selecting repair techniques for diaphragmatic defects of different sizes in neonates with congenital diaphragmatic hernia (CDH).
Materials and methods. A retrospective analysis of medical records of 61 neonates with CDH treated in 2013-2025 was performed. According to defect size, patients were divided into two groups: Group I – 40 (65.6%) children with small and moderate defects (types A and B), and Group II – 21 (34.4%) patients with large and total defects (types C and D). Anatomical features of defects, surgical repair methods, postoperative survival, and recurrence rates were analyzed.
Results. The mean defect area was 10.82±2.87 cm² in Group I and 24.21±4.52 cm² in Group II. Posterolateral localization predominated in Group I (78.9%), whereas posteromedial defects were more frequent in Group II (30.0%). Primary repair using native diaphragmatic tissue was performed in all patients of Group I and in 52.3% of Group II. The remaining neonates with large defects underwent combined repair using a flap from the anterior abdominal wall (AAW) muscles. In three cases of diaphragmatic aplasia, complete reconstruction was achieved using an autologous AAW muscle graft. Postoperative survival was 97.5% in Group I and 76.2% in Group II. No hernia recurrence was observed among surviving patients.
Conclusions. Primary repair using native tissue is the method of choice for small and moderate diaphragmatic defects. In large and total defects, reconstruction using AAW muscle flaps provides effective outcomes with no recurrence. A differentiated approach to surgical repair based on defect size improves outcomes of CDH treatment in neonates.
The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from the patients’ legal representatives.
The authors declare no conflict of interest.
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