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Shlomo Kyzer, MD; Lea Sirota, MD; Chaim Chaimoff, MD

Arch Surg. 2004;139:296-298.

Hypothesis  Newborns with congenital diaphragmatic hernia (CDH) have a high risk of mortality, ranging from 50% to 70%. Tensioned closure of the narrowed abdominal cavity is detrimental.

Patients and Methods  Twelve high-risk newborns underwent operation for CDH. To achieve tension-free closure of the abdominal wall, a Silastic patch was used. The Silastic patch was sutured intermittently to the edges of the abdominal wall fascia with absorbable sutures and left open to the air. The skin was not closed above the Silastic patch, which was lubricated with 1% gentamicin sulfate ointment.

Results  Eleven patients (91.6%) survived. No local or systemic septic complication occurred. The abdominal wall was gradually closed, and total closure was achieved within 4 to 6 weeks (mean, 4.9 weeks).

Conclusion  Because of the high survival rate and the complication-free rapid healing of the abdominal wall, the technique can be used in any case of CHD in which tension-free closure of the abdominal wall cannot be achieved by other methods.

From the Department of Surgery B, Wolfson Medical Center, Holon (Dr Kyzer); Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Prof Sirota); and the Department of Surgery A, Rabin Medical Center, Campus Golda, Hasharon (Prof Chaimoff), Israel.