CDH - MIS vs. Open: Update Course 2015

In multivariate analysis of CDH repair complications, open repair is associated with higher risk of small bowel obstruction compared to MIS repair.

In primary CDH repairs, recurrence rate was 3.9% in open repairs versus 7.8% in MIS repairs, though this difference was not statistically significant.

Muscle flap repair for CDH is not currently performed using minimally invasive technique.

At Cincinnati Children's Hospital, zero recurrences occurred in muscle flap CDH repairs over a 10-year period.

At Cincinnati, patients who received patches or other repair types had recurrences, but muscle flap patients had no recurrences.

Gore-Tex patch repairs for CDH have well-documented moderate recurrence rates.

Primary CDH repairs represent a different patient population than those requiring muscle flap or Gore-Tex patch, and outcomes should not be directly compared.

All patch repair techniques for CDH have high recurrence rates except for muscle flaps.

In near-agenesis CDH cases repaired thoracoscopically, outcomes were no better than open repair despite longer operative time.

For primary CDH repairs, thoracoscopic approach is a good option with potential advantages including ability to place more sutures and ensure adequate lateral corner closure to prevent recurrence.

Biologic mesh used alone for CDH patch repair has a high recurrence rate and has been largely abandoned.

Technical principles for CDH repair include: use open approach for large defects, avoid biologic mesh alone, minimize tension on repair, and place adequate sutures.

Among CDH patients who had been on ECMO, 25% had defects small enough to be successfully repaired thoracoscopically.

Starting with thoracoscopic approach in all CDH patients allows rapid assessment of defect size and conversion to open if needed, adding only 5-10 minutes to operative time.