Delayed Dynamic Abdominal Wall Closure Following Congenital Diaphragmatic Hernia Repair Using a Gore-Tex® Patch: A Single-Center Retrospective Experience for a Complex Pediatric Thoracic Disease

Introduction: delayed abdominal closure following congenital diaphragmatic hernia (CDH) repair is required in patients with large defects in whom primary fascial closure would risk abdominal compartment syndrome. Several strategies have been described, but most require prolonged time to definitive closure. We present a novel technique based on a Gore-Tex® abdominal patch with dynamic traction under intra-abdominal pressure monitoring. Methods: retrospective observational study of 41 neonates undergoing CDH repair at a tertiary referral center (2015–2023). Patients were divided into primary closure (n = 27) and delayed dynamic abdominal wall closure (DDAC) (n = 14) groups. Baseline characteristics, surgical outcomes, and mortality were compared between groups using Fisher’s exact test and the Wilcoxon rank-sum test. Results: patients requiring DDAC had more severe baseline disease, including lower O/E LHR (26.30 [21.40–31.00] vs. 42.00 [34.00–46.00], p < 0.001), higher rates of liver herniation (13/14 vs. 4/27, p < 0.001), more advanced defect type (p < 0.001) and greater need of ECMO (9/14 vs. 3/27, p < 0.001). Definitive fascial closure was achieved at a median of 6 days. In-hospital mortality after diaphragmatic repair was 19.5% (8/41), with 7 deaths occurring in the DDAC group. Mortality was strongly associated with the gradient of disease severity across prenatal and anatomical markers, although an independent contribution of the abdominal closure strategy cannot be excluded. Conclusions: DDAC achieves early definitive fascial closure and appears technically feasible in CDH patients unsuitable for primary closure. Higher mortality in this group was strongly associated with baseline disease severity, though its independent relationship with the closure technique remains to be established.