Muensterer Nadine R, Weigl Elena, Holler Anne-Sophie, Zeller Christiane, Häberle Beate, Muensterer Oliver J
Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU Medical Center, 80337 Munich, Germany.
Children (Basel). 2023 Dec 28;11(1):35. doi: 10.3390/children11010035.
Congenital diaphragmatic hernia (CDH) repair can be challenging, particularly when a larger defect is present. Barbed sutures prevent the suture from slipping back after approximation of the tissues. Although introduced almost 2 decades ago, barbed sutures have not been widely used for CDH repair. We report our initial experience and pitfalls.
All patients presenting with CDH from 2021 onward underwent repair using barbed sutures. Demographics, operative parameters, complications, and outcomes were prospectively recorded.
A total of 13 patients underwent CDH repair during the study interval (median age 6 days, range 3 days to 5.75 years). Median operative time was 89 min (range 46 to 288 min). Five thoracoscopic and eight open procedures were performed. Severe pulmonary hypertension and ECMO (extracorporeal membrane oxygenation) were considered contraindications for thoracoscopic repair. The included patients were compared to a historic controlled group performed without barbed sutures. The barbed suture facilitated easy and quick closure of the defects in most cases and obviated the need for knot tying. One patient in the thoracoscopic group had a patch placed due to high tension after the barbed sutures tore the diaphragm. At a median follow-up time of 15 months (range 2 to 34 months), one patient had died, and one patient with complete diaphragmatic agenesis was home-ventilated. There were no recurrences. Median operative time trended lower (89 min) than in the historic control group repaired without barbed sutures (119 min, < 0.06) after eliminating outliers with large, complex patch repairs.
Barbed sutures simplify congenital diaphragmatic hernia repair regardless of whether a minimal-invasive or open approach is performed. Patch repair is not a contraindication for using barbed sutures. The resulting potential time savings make them particularly useful in patients with cardiac or other severe co-morbidities in which shorter operative times are essential. In cases with high tension, though, the barbs may tear through and produce a "saw" effect on the tissue with subsequent damage.
先天性膈疝（CDH）修复手术可能具有挑战性，尤其是在存在较大缺损的情况下。倒刺缝线可防止组织缝合后缝线滑回。尽管倒刺缝线在近20年前就已问世，但尚未广泛用于CDH修复。我们报告了我们的初步经验和陷阱。
2021年起所有诊断为CDH的患者均使用倒刺缝线进行修复。前瞻性记录患者的人口统计学、手术参数、并发症和结局。
在研究期间，共有13例患者接受了CDH修复（中位年龄6天，范围3天至5.75岁）。中位手术时间为89分钟（范围46至288分钟）。其中5例采用胸腔镜手术，8例采用开放手术。严重肺动脉高压和体外膜肺氧合（ECMO）被视为胸腔镜修复的禁忌证。将纳入的患者与未使用倒刺缝线的历史对照组进行比较。在大多数情况下，倒刺缝线便于快速轻松地闭合缺损，无需打结。胸腔镜组有1例患者在倒刺缝线撕裂膈肌后因张力过高而放置了补片。中位随访时间为15个月（范围2至34个月），1例患者死亡，1例完全性膈缺如患者在家中接受通气治疗。无复发病例。在排除因大型复杂补片修复导致的异常值后，中位手术时间（89分钟）比未使用倒刺缝线的历史对照组（119分钟，P<0.06）更短。
无论采用微创还是开放手术方式，倒刺缝线均可简化先天性膈疝的修复。补片修复并非使用倒刺缝线的禁忌证。由此节省的潜在时间使其在心脏或其他严重合并症患者中特别有用，因为这些患者需要更短的手术时间。不过，在张力较高的情况下，倒刺可能会撕裂组织并产生“锯”效应继而造成损伤。
