Xenoperixardium in congenital and acquired diaphragmatic hernia in children

Abstract

A surgical management of extensive diaphragmatic defects is an actual problem in pediatric thoracic surgery. Despite of a large number of existing diaphragmatic prostheses, the search for an ideal plastic material is still going on. Material and methods. The authors analyze the effectiveness of xenopericardium in 15 children, aged 2 days - 17 years, with extensive diaphragmatic defects. Congenital hernia was in 8 (53.3%) patients, recurrence of congenital hernia - in 4 (26.7%) children, acquired hernia - in 3 (20.0%) children. The thoracoscopic approach was applied in 10 (66.7%) patients, thoracotomy - in 2 (13.3%) patients, laparotomy - in 3 (20.0%). Results. Diaphragmatic integrity was restored in all operated children. There were no any relapse of diaphragmatic hernia at the late postoperative period. There were no any xenopericardium rejection either. The article describes two clinical observations. In the first case, a 15-years-old girl with an extensive defect in her left dome of the diaphragm after the resection of lower lobe in the left lung and the diaphragmatic dome because of alveolar rhabdomyosarcoma had retoracotomy on the left and prosthetics of the diaphragm with a xenopericardium plate. In the second case, a thoracoscopic plastic surgery on the diaphragmatic dome with a xenopericardium plate was made in a newborn baby with aplasia of the right diaphragm on the 3rd day of his life. A long-lasting effect was obtained in both cases. Conclusions. Diaphragmatic plasty with xenopericardium can be successfully applied in children with extensive congenital and acquired diaphragmatic defects. The surgical technique with xenopericardium is possible both in open surgeries and in thoracoscopic interventions.