Volume 9, Issue 4 (2025)
SJMR 2025, 9(4): 239-248 |
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Seyyedi S J. Innovative use of dual mesh in infants with diaphragmatic hernia: a case report. SJMR 2025; 9 (4) : 8
URL: http://saremjrm.com/article-1-354-en.html
URL: http://saremjrm.com/article-1-354-en.html
Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran.Medical Sciences, Tehran, Iran
Abstract: (958 Views)
Background and Objective: Congenital diaphragmatic hernia (CDH) is one of the most critical neonatal emergencies, often associated with severe pulmonary and cardiac complications, necessitating immediate surgical intervention. Managing intra-abdominal pressure (IAP) following the reduction of herniated abdominal viscera presents a major surgical challenge due to the limited capacity of the neonatal abdominal cavity. This study introduces and evaluates a novel surgical technique utilizing dual mesh reinforcement to minimize postoperative complications in neonates with CDH.
Methods: This case series includes 30 neonates with CDH operated between 2009 and 2024 at tertiary care hospitals. After returning the herniated viscera to the abdominal cavity, fascial release was performed, and a dual or physio mesh was placed directly on the fascia. Skin closure was achieved using an undermining technique, and Hemovac drains were inserted to prevent fluid accumulation. Postoperative outcomes, including complications such as infection, seroma formation, skin necrosis, and mortality rates, were systematically evaluated.
Results: The new technique resulted in excellent survival outcomes, with no mortality directly attributed to the surgical method. Only three cases experienced minor local complications, including erosion and mild infection, which were successfully managed with minimal intervention. Long-term follow-ups demonstrated satisfactory growth and quality of life in all patients.
Conclusion: The novel application of dual mesh for online fascial reinforcement and abdominal wall reconstruction in neonates with CDH appears to be a safe and effective technique. It offers a viable surgical alternative, especially in centers lacking advanced neonatal intensive care unit (NICU) facilities, significantly reducing morbidity and mortality rates.
Methods: This case series includes 30 neonates with CDH operated between 2009 and 2024 at tertiary care hospitals. After returning the herniated viscera to the abdominal cavity, fascial release was performed, and a dual or physio mesh was placed directly on the fascia. Skin closure was achieved using an undermining technique, and Hemovac drains were inserted to prevent fluid accumulation. Postoperative outcomes, including complications such as infection, seroma formation, skin necrosis, and mortality rates, were systematically evaluated.
Results: The new technique resulted in excellent survival outcomes, with no mortality directly attributed to the surgical method. Only three cases experienced minor local complications, including erosion and mild infection, which were successfully managed with minimal intervention. Long-term follow-ups demonstrated satisfactory growth and quality of life in all patients.
Conclusion: The novel application of dual mesh for online fascial reinforcement and abdominal wall reconstruction in neonates with CDH appears to be a safe and effective technique. It offers a viable surgical alternative, especially in centers lacking advanced neonatal intensive care unit (NICU) facilities, significantly reducing morbidity and mortality rates.
Article number: 8
Keywords: Congenital Diaphragmatic Hernia, Surgical Mesh, Abdominal Compartment Syndrome, Intra-Abdominal Pressure, Neonatal Intensive Care Units.
Article Type: Series Report |
Subject:
Childbirth
Received: 2025/01/14 | Accepted: 2025/02/8 | Published: 2025/03/25
Received: 2025/01/14 | Accepted: 2025/02/8 | Published: 2025/03/25
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References
1. Zani, A., et al., Congenital diaphragmatic hernia. Nature Reviews Disease Primers, 2022. 8(1): p. 37. [DOI:10.1038/s41572-022-00362-w] [PMID]
2. Poerwosusanta, H., G. MD, and M.J. MD, Optimal early surgery timing for congenital diaphragmatic hernia: A systematic review. Med J Malaysia, 2024. 79: p. 77.
3. Perrone, E.E. and J.A. Deprest, Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: a narrative review of the history, current practice, and future directions. Translational pediatrics, 2021. 10(5): p. 1448. [DOI:10.21037/tp-20-130] [PMID] []
4. Van Calster, B., et al., The randomized Tracheal Occlusion To Accelerate Lung growth (TOTAL)-trials on fetal surgery for congenital diaphragmatic hernia: reanalysis using pooled data. American Journal of Obstetrics and Gynecology, 2022. 226(4): p. 560. e1-560. e24. [DOI:10.1016/j.ajog.2021.11.1351] [PMID]
5. Logan, J., et al., Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies. Journal of Perinatology, 2007. 27(9): p. 535-549. [DOI:10.1038/sj.jp.7211794] [PMID]
6. Snoek, K.G., et al., Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO consortium consensus-2015 update. Neonatology, 2016. 110(1): p. 66-74. [DOI:10.1159/000444210] [PMID]
7. Baird, R., et al., Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network. Journal of pediatric surgery, 2011. 46(5): p. 801-807. [DOI:10.1016/j.jpedsurg.2011.02.008] [PMID]
8. Neshat, H., et al., Organisational challenges of pain management in neonatal intensive care unit: a qualitative study. BMJ open, 2023. 13(9): p. e072695. [DOI:10.1136/bmjopen-2023-072695] [PMID] []
9. Habibelahi, A., et al., Clinical cause of neonatal mortality in Iran: analysis of the national Iranian Maternal And Neonatal network. BMJ Paediatr Open, 2024. 8(1). [DOI:10.1136/bmjpo-2023-002315] [PMID] []
10. Thabet, F.C. and J.C. Ejike, Intra-abdominal hypertension and abdominal compartment syndrome in pediatrics. A review. Journal of Critical Care, 2017. 41: p. 275-282. [DOI:10.1016/j.jcrc.2017.06.004] [PMID]
11. Kirby, E. and R. Keijzer, Congenital diaphragmatic hernia: current management strategies from antenatal diagnosis to long-term follow-up. Pediatric Surgery International, 2020. 36: p. 415-429. [DOI:10.1007/s00383-020-04625-z] [PMID]
12. Gonzalez, R., et al., Absorbable Versus Nonabsorbable Mesh Repair of Congenital Diaphragmatic Hernias in a Growing Animal Model. Journal of Laparoendoscopic & Advanced Surgical Techniques, 2011. 21(5): p. 449-454. [DOI:10.1089/lap.2010.0409] [PMID]
13. Saad, A.R. and B.L. Corey, Classification and evaluation of diaphragmatic hernias. The SAGES Manual of Foregut Surgery, 2019: p. 225-239. [DOI:10.1007/978-3-319-96122-4_18]
14. Thambusamy, E., et al., Intra-abdominal hypertension in neonates following congenital diaphragmatic hernia repair: Correlation with early postoperative respiratory and gastrointestinal outcomes. J Pediatr Surg, 2022. 57(2): p. 199-202. [DOI:10.1016/j.jpedsurg.2021.10.029] [PMID]
15. Orenstein, M., et al., Patients with type 1 Gaucher disease in South Florida, USA: demographics, genotypes, disease severity and treatment outcomes. Orphanet journal of rare diseases, 2014. 9: p. 1-10. [DOI:10.1186/1750-1172-9-45] [PMID] []
16. Smith, M.W., et al., Incorporating guideline adherence and practice implementation issues into the design of decision support for beta-blocker titration for heart failure. Applied clinical informatics, 2018. 9(02): p. 478-489. [DOI:10.1055/s-0038-1660849] [PMID] []
17. Newcombe, J., M. Mathur, and J.C. Ejike, Abdominal compartment syndrome in children. Critical care nurse, 2012. 32(6): p. 51-61. [DOI:10.4037/ccn2012761] [PMID]
18. Coughlin, M.A., et al., Prenatally diagnosed severe CDH: mortality and morbidity remain high. Journal of pediatric surgery, 2016. 51(7): p. 1091-1095. [DOI:10.1016/j.jpedsurg.2015.10.082] [PMID]
19. Middleton, P.G., et al., Cystic Fibrosis Related Diabetes: Potential pitfalls in the transition from paediatric to adult care. Paediatric Respiratory Reviews, 2014. 15(3): p. 281-284. [DOI:10.1016/j.prrv.2014.05.003] [PMID]
20. Walani, S.R., N. Penny, and D. Nakku. The global challenges of surgical congenital anomalies: evidence, models, and lessons. in Seminars in Pediatric Surgery. 2023. Elsevier. [DOI:10.1016/j.sempedsurg.2023.151348] [PMID]
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