Musculoskeletal deformities following repair of large congenital diaphragmatic hernias

Abstract

Split-abdominal wall muscle flap Purpose: Large congenital diaphragmatic hernias (CDH) can be repaired with either a muscle flap or prosthetic patch. The purpose of this study was to assess the frequency and severity of scoliosis, chest wall, and abdominal wall deformities following these repairs. Methods: Neonates who underwent CDH repair (1989-2012) were retrospectively reviewed. We then validated our retrospective review by comparing results of a focused radiologic evaluation and clinical examination of patients with large defects seen in prospective follow-up clinic. Tests for association were made using Fisher's exact test. Results: 236 patients survived at least 1 year. Of these patients, 30 had a muscle flap, and 13 had a patch repair. Retrospectively, we identified pectus in 9% of primary repairs, 47% of flap repairs, and 54% of patch repairs. We identified scoliosis in 7% of primary repairs, 13% of flap repairs, and 15% of patch repairs. Prospectively, 75% of flap patients and 67% of patch patients had pectus and 13% of flap patients and 33% of patch patients had scoliosis. There was no significant difference between flap and patch patients. Conclusions: Scoliosis and pectus deformity were common in children with large CDH. The operative technique did not appear to affect the incidence of subsequent skeletal deformity. © 2014 Elsevier Inc. All rights reserved. Large congenital diaphragmatic hernias (CDHs) require repair with either a patch or an autologous tissue transfer. Repair with a prosthetic patch is the technique used by most surgeons Methods Study population After obtaining approval from the Institutional Review Board, a retrospective review of all children with CDH repair at our regional tertiary care children's hospital from 1989 to 2012 was performed. The patients were categorized by the technique of their repair. Repair types included primary repair, split abdominal wall muscle flap and synthetic patch. Paper and electronic medical records were reviewed to obtain demographic data, and diagnosis of skeletal deformities as well as any treatment for the skeletal deformities. Electronic charts were searched for the key words "pectus" and "scoliosis," and those specific notes were reviewed. These diagnoses were made by a variety of physicians including radiologists, orthopedists and primary care physicians and were not always confirmed by a focused follow-up visit by a pediatric surgeon. In order to check the validity of our retrospective review, patients with large defects were seen prospectively for focused follow-up and a single pediatric radiologist (G.H.) reviewed the most current chest radiograph to evaluate for scoliosis greater than 10 degrees. The results of follow-up were correlated with our retrospective review