What is the best prosthetic material for patch repair of congenital diaphragmatic hernia? Comparison and meta-analysis of porcine small intestinal submucosa and polytetrafluoroethylene

J Pediatr Surg. 2012 Aug;47(8):1496-500. doi: 10.1016/j.jpedsurg.2012.01.009.


Background: Prosthetic patches are widely used for congenital diaphragmatic hernia (CDH) repair. We compared the complication rate of absorbable (Surgisis [SIS]; Cook Biotech, Inc, West Lafayette, IN) and nonabsorbable (polytetrafluoroethylene [PTFE]) materials for this purpose.

Methods: This is a retrospective review of all neonates with CDH undergoing patch closure at our institution over 10 years. Meta-analysis was also performed combining our data with the published literature examining the effect of patch type on recurrence and small bowel obstruction (SBO).

Results: Primary patch (13 SIS, 9 PTFE) repair was performed in 22 (26%) of 84 patients with CDH. Groups were comparable in terms of demographics, hospital stay, ventilator days, need for high frequency oscillation, age at surgery, and length of follow-up. Likewise, recurrence rate (SIS, 4 [31%]; PTFE, 3 [33%]; P, nonsignificant [NS]), incidence of postoperative SBO (SIS, 1 [7%] vs PTFE, 2 [22%]; P, NS), and mortality (SIS, 2 [15%] and PTFE, 2 [22%]; P, NS) were similar. Meta-analysis failed to find a significant difference between SIS and PTFE both for recurrence rate (odds ratio, 1.21 [0.51-2.84]; P, NS) and SBO (odds ratio, 1.47 [0.44-4.96]; P, NS).

Conclusions: There was no difference in the incidence of CDH recurrence, SBO, or mortality post-CDH patch repair using either SIS or PTFE in our series. Meta-analysis failed to show any difference in recurrence and SBO rates between the 2 materials.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Animals
  • Bioprosthesis*
  • Female
  • Foreign-Body Reaction / epidemiology
  • Foreign-Body Reaction / etiology
  • Hernia, Diaphragmatic / mortality
  • Hernia, Diaphragmatic / surgery*
  • Hernias, Diaphragmatic, Congenital*
  • Herniorrhaphy / instrumentation*
  • Herniorrhaphy / methods
  • Humans
  • Infant, Newborn
  • Intestinal Obstruction / epidemiology
  • Intestinal Obstruction / prevention & control
  • Intestine, Small
  • Male
  • Polytetrafluoroethylene*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Prosthesis Failure
  • Recurrence
  • Retrospective Studies
  • Surgical Mesh*
  • Thorax / growth & development
  • Treatment Outcome
  • Wound Healing


  • Polytetrafluoroethylene