Journal of Pediatric Surgery Open (Dec 2023)
Use of self-extendable mesh in the minimally invasive treatment of posterolateral diaphragmatic hernia, a novel device
Abstract
Background: Congenital diaphragmatic hernia (CDH) is a pathology found in neonates, though it can affect individuals of various ages. The definitive treatment for this condition is surgical, either through an open or minimally invasive approach. Hernial defects not allowing primary closure must be corrected with a mesh. There is no specific mesh for this pathology. We describe the use of a self-extendable mesh based on a market-available mesh for the closure of a CDH that facilitates its placement and suture to the diaphragm using a minimally invasive technique. Methods: We conducted a retrospective longitudinal study from January 2019 to January 2023. The study included patients under the age of 18 with a confirmed diagnosis of CDH who underwent minimally invasive surgery with the placement of a self-extendable mesh. A minimum follow-up period of six months was established. Descriptive statistics were applied to analyze various variables, including age at diagnosis, associated pathologies, hernia classification, surgical time, and postoperative parameters, such as complications, respiratory and gastrointestinal symptoms, recurrence, and thoracic alterations. Results: We included five patients with CDH. Two patients were diagnosed in the neonatal period, two between 28 days of life and one year, and one after the first year of life. All patients had posterolateral hernias; three were left-sided, and two were right-sided. Four had a type C defect, and one had a type B defect. All patients were treated by minimally invasive surgery, through thoracoscopy, with a surgical time between 89 and 120 min. There were no intraoperative complications or conversions to open surgery. Short and medium-term follow-up was performed in the remaining patients, the shortest follow-up period being 19 months and the longest reaching 36 months. No recurrence of the defect or thoracic or vertebral deformities were reported. Conclusions: The modified self-extendable mesh is a device that offers a safe and effective way of correcting CDH, facilitating the placement and suture process to the native tissue while reducing the risk of injury to the abdominal viscera. Although we cannot definitively conclude that the surgical time decreases based on our limited number of cases, the mesh shows promise as a valuable tool in treating CDH. Further research and a larger sample are necessary to determine the effects on surgical time.
