Congenital diaphragmatic hernia repair: Patches, muscle flaps, and the search for the ideal technique

There is a variable defect size in both left and right-sided congenital diaphragmatic hernia. The majority can be repaired using primary apposition but in a significant minority this will not be possible. A number of surgical techniques have been developed to overcome this problem but in principle these can be divided into the creation of a muscle flap usually derived from layers of the abdominal wall rotated into the gap or the insertion of a prosthetic patch. The composition of the latter has also been subject to variation and has been largely non-absorbable or absorbable and dependent on surgical preference. This article summarises the debate at a recent conference symposium by illustrating two forms of prosthetic patch repairs and a muscle flap repair. It concludes with an update on the efforts that have been made to achieve this using various tissue engineering technologies.