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.

Recurrence rates in primary CDH repairs were 3.9% for open and 7.8% for MIS repairs, a difference that was not statistically significant.

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

At Cincinnati Children's, zero recurrences occurred in muscle flap CDH patients over 10 years.

Patients who received patches or other repair types had recurrences, but muscle flap patients did not.

Primary CDH repairs represent a different patient population than those requiring muscle flap or Gore-Tex, making direct comparison problematic.

For primary CDH repairs, laparoscopic or thoracoscopic approach offers better patient selection compared to open repair.

All surgeons have high recurrence rates with patch repair for CDH except when using muscle flaps.

For near-agenesis CDH defects (not complete agenesis), MIS repair resulted in poor outcomes despite technical success, similar to open repair outcomes.

For large CDH defects, open repair is more expeditious than prolonged MIS attempts.

For primary CDH repairs, thoracoscopic approach is a good option with potential to reduce recurrence by placing more sutures and ensuring adequate lateral corner closure.

Biologic mesh used alone as a patch for CDH has a high recurrence rate.

Biologic mesh for CDH repair has been largely abandoned by surgeons.

Among CDH patients who have been on ECMO, 25% had defects small enough to be successfully repaired with laparoscopic approach.

Initial laparoscopic assessment of CDH defect size adds only 5-10 minutes to operative time before converting to open if needed.

Recent papers have addressed hypercapnia concerns during MIS CDH repair, requiring communication with anesthesiology.