Long-term effectiveness of transversus abdominis single muscle flap repair for large congenital diaphragmatic hernia

AIM: Surgical repair of large congenital diaphragmatic hernia (CDH) remains a challenge. Although many different procedures are described, none has become a 'gold standard'. This study aimed to evaluate long-term results of the single muscle flap repair to avoid using a prosthetic patch. MATERIALS AND METHODS: After institutional review board approval (#15.92), we conducted a retrospective study including all neonates who underwent single transversus abdominis muscle flap repair as first-line treatment for large CDH between 1995 and 2023 in our institution. Survivors were assessed clinically for growth, hernia recurrence, surgical complications, abdominal deformities, chest wall deformities and scoliosis. Data are reported as medians with ranges. RESULTS: Twenty-seven patients underwent surgical repair at a median age of 29 hours of life (4-96). All had an antenatal diagnosis, and 25 (92.6%) were left-sided defects. Twenty-two patients survived to hospital discharge and were available for long-term follow-up. At a median follow-up of 8.9 years (0.5-19.1), no diaphragmatic hernia recurrence was observed. Minor donor-site abdominal wall bulging occurred in 5 patients (23.8%), and 1 patient (4.5%) developed an abdominal wall hernia. Adhesive bowel obstruction requiring surgery occurred in 5 patients (22.7%). Pectus deformities were observed in 7 patients (33.3%). Thoracogenic scoliosis occurred in 7 patients (33.3%), with surgical treatment required in one case. CONCLUSION: Single transversus abdominis muscle flap repair provides durable closure of large congenital diaphragmatic hernia defects with no recurrence at long-term follow-up and acceptable morbidity. This technique represents a reliable alternative to prosthetic patch repair for large diaphragmatic defects.