[size=6]You are performing a repair of a large congenital diaphragmatic hernia on an infant who is on ECMO. The hernia is not amenable to a primary repair, so you opt to perform a muscle-flap repair. When compared to patch repairs performed while on ECMO, you would expect which of the following outcomes?

 

a Longer operative time

 

b Reduced post-op PRBC transfusions

 

c Reduced time on ECMO

 

d Increased risk of hernia recurrence

 

e Increased reoperations for bleeding[/size]

A

E

correct answer

b Reduced post-op PRBC transfusions

 

Traditionally, many surgeons have steered away from performing muscle flap repairs for patients on ECMO given that assumption that this technique would increase the risk of hemorrhage. However, recent data has seems to argue that this is not true. In 2023, Vaughn et al. published their results of 52 patients who underwent CDH repair while on ECMO—18 underwent patch repairs while 34 underwent muscle flap repairs. Muscle flap repairs were associated with shorter operative times, a lower risk of reoperation for bleeding, lower need for PRBC transfusions and improved survival to discharge. No studies have directly compared the risk of infection between these two techniques, but muscle-flap repairs do avoid the implantation of synthetic foreign body. Finally, multiple studies (Nasr et al. J Pediatr Surg 2010; Aydin et al. Pediatr Surg Int 2020; Barnhart et al. J Pediatr Surg 2012) that have compared these two techniques have observed either an equal or lower risk of recurrence following muscle flap repair.