Reconstruction of the diaphragm in extensive congenital diaphragmatic hernia

Congenital diaphragmatic hernia presents a wide spectrum of anatomical variants ranging from small defects to a complete absence of the hemidiaphragm. The surgical correction of this congenital anomaly consists of restoring the continuity of the diaphragmatic barrier after the herniated viscera has been replaced into the abdominal cavity. In some babies primary repair of the diaphragm is not possible due to a significant extent of a defect. In these cases prosthetic diaphragm reconstruction must be carried out. In this paper the pathophysiological aspects of reconstruction of the diaphragm in babies affected by congenital diaphragmatic hernia are discussed. The various methods of diaphragmatic repair including use of prosthetic materials, muscle flaps and autogenous graft are reviewed. The results of experimental studies in animals comparing nonabsorbable and absorbable materials and muscle flaps as a diaphragmatic patch are presented. In view of the fact that the modern neonatal intensive medicine allows more babies with an extensive diaphragmatic defect to survive, the use of various reconstructive techniques will be without doubt play a more important role in their surgical management.