Muscle Flap Technique Safe for On-ECMO Congenital Diaphragmatic Hernia Repair

• Published in: Journal of pediatric surgery Vol. 59; no. 5; pp. 962 - 968
• Main Authors: Vaughn, Alyssa E., Lyttle, Bailey D., Louiselle, Amanda E., Cooper, Emily, Niemiec, Stephen M., Phillips, Ryan, Hilton, Sarah A., Kinsella, John P., Gien, Jason, Derderian, S Christopher, Liechty, Kenneth W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2024
• Subjects: Bleeding complications; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Muscle flap repair; Surgical technique; Prosthetic patch; ECMO; DOL; pRBCs; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Bleeding complications; CDH; PTFE; cryo; Surgical technique; PPLV; AP; abdominal wall muscle flap, transversus abdominis muscle flap; O:E LHR; FFP; Muscle flap repair; LHR; kg; mL
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.11.022

Prosthetic patches (patch) and muscle flaps (flap) are techniques used for repair of congenital diaphragmatic hernia (CDH) with a large defect unamenable to primary closure. We hypothesized that the flap technique for CDH repair while on extra-corporeal membrane oxygenation (on-ECMO) would have decreased bleeding complications compared to patch due to the hemostatic advantage of native tissue.
A single-center retrospective comparative study of patients who underwent on-ECMO CDH repair between 2008 and 2022 was performed.
Fifty-two patients met inclusion criteria: 18 patch (34.6%) and 34 flap (65.4%). There was no difference in CDH severity between groups. On univariate analysis, reoperation for surgical bleeding was lower following flap repair compared to patch (23.5% vs 55.6%, respectively; p = 0.045), 48-h postoperative blood product transfusion was lower after flap repair (132 mL/kg vs 273.5 mL/kg patch; p = 0.006), and two-year survival was increased in the flap repair group compared to patch (53.1% vs 17.7%, respectively; p = 0.036). On multivariate analysis adjusting for CDH side, day on ECMO repaired, and day of life CDH repaired, flap repair was significantly associated with lower five-day postoperative packed red blood cell transfusion amount, improved survival to hospital discharge, and improved two-year survival.
Our experience suggests that the muscle flap technique for on-ECMO CDH repair is associated with reduced bleeding complications compared to prosthetic patch repair, which may in part be responsible for the improved survival seen in the flap repair group. These results support the flap repair technique as a favored method for on-ECMO CDH repair.
Level III.
•The abdominal wall muscle flap technique can be used to repair large CDH defects and is feasible to perform on-ECMO.•The muscle flap technique is safe to perform on-ECMO and is associated with decreased postoperative bleeding complications, potentially making it the favored technique for large CDH defects which require on-ECMO repair.