EXPERIENCE WITH ABDOMINAL-WALL CLOSURE FOR PATIENTS WITH CONGENITAL DIAPHRAGMATIC-HERNIA REPAIRED ON ECMO

Congenital diaphragmatic hernia (CDH) and its attendant lack of abdomi nal domain can create major technical challenges with respect to diaph ragmatic and abdominal wall reconstruction, especially in seriously il l infants who require extracorporeal membrane oxygenation (ECMO). The authors reviewed the medical records of all infants with CDH repaired on ECMO at their institution (group 1, 15 patients), and compared them with infants having CDH repair before ECMO (group 2, 20 patients) and with those who had CDH repair but did not require ECMO (group 3, 15 p atients). Thirty-seven of 50 patients survived (74%): 10 in group 1, 1 2 in group 2, and all 15 in group 3. There was a statistically signifi cant difference (P < .001) with respect to the requirement of a polyte trafluoroethylene (PTFE) diaphragmatic patch for patients in group 1 v ersus those in both groups 2 and 3. There was also a significant diffe rence in the number of patients in whom the abdomen could not be close d (P < .001 for group 1 v groups 2 and 3). Infants who require ECMO be fore CDH repair are more likely to have large diaphragmatic defects th at require prosthetic reconstruction, and abdominal wall closure probl ems resulting from loss of abdominal domain, which further complicate the management of the physiological derangements from pulmonary hypopl asia and persistent pulmonary hypertension. Copyright (C) 1995 by W.B. Saunders Company