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Pediatr Surg Int (2005) 21: 6467 DOI 10.1007/s00383-004-1267-7
TECHNICAL INNOVATION
Tadaharu Okazaki Shiro Hasegawa Naoto Urushihara Koji Fukumoto Kaoru Ogura Shintaro Minato Shoko Kawashima Sumio Kohno
Toldts fascia ap: a new technique for repairing large diaphragmatic hernias
Published online: 24 September 2004 Springer-Verlag 2004
Abstract The most popular techniques for repairing large diaphragmatic defects involve the use of synthetic patches. We present an alternative approach using living tissue. We reviewed our cases of congenital diaphragmatic hernia (CDH) diagnosed within the rst 24 h of life from 1991 to 2003. Toldts fascia (TF) ap was used to repair defects that were too large to repair primarily even though the anterior rim of the diaphragm was present. After conrming that a small medial muscle remnant of the diaphragm was present, its mesothelial covering was incised, and the incision was extended to the TF far enough to create a ap suciently large to repair the defect. The TF ap, consisting of the small medial muscle remnant, TF, peritoneum, and retroperitoneal connective tissue, was mobilized carefully from the ipsilateral kidney and adrenal gland, and the repair completed with interrupted sutures using nonabsorbable material. We used this TF ap approach in seven of 43 patients with CDH. Two had right-sided CDH. Six survived. The mean size of the diaphragmatic defects in the seven TF ap cases was5.430.533.861.07 cm, which was signicantly larger than the defects in direct primary repair cases(3.400.772.030.59 cm) (p<0.01). The six survivors had good outcomes, and none of them have had recurrence of herniation or required any additional surgical intervention (mean follow-up period: 4.7 years). To the best of our knowledge, this is the rst report of TF being used to repair large diaphragmatic hernias. Our technique is simple and has proven to be reliable for durable restoration of the diaphragm, suggesting that it could reduce the dependence on synthetic patch repair, which is associated with certain long-term complications.
Keywords Congenital diaphragmatic hernia Toldts fascia ap Patch repair
Introduction The survival rate for patients with congenital diaphragmatic hernia (CDH) has improved recently [1, 2], and more dicult cases with larger defects [3, 4] are being treated successfully. When CDH is large, the defect is commonly closed with synthetic patches because it is too large to repair...