Lateral Release in Neonatal Congenital Diaphragmatic Hernia Is Associated with Faster Recovery Compared to Abdominal Wall Patch Repair: A Preliminary Prospective Cohort Study.

Abstract

Open repair of congenital diaphragmatic hernia (CDH) in neonates often requires surgical reconstruction of the abdominal wall. Lateral release (LR) of the abdominal wall fascia, a novel technique avoiding prosthetic patches, offers potential advantages. However, data comparing its outcomes to traditional patch repair are limited.A preliminary prospective cohort study was conducted at the University Medical Center Mannheim from 2021 to 2024, including neonates undergoing CDH surgery with abdominal wall reconstruction via direct closure, LR, or patch repair based on intraoperative surgeon decision. Perioperative, postoperative, and short-term outcome data were analyzed during our standardized follow-up protocols and compared between groups.Among 77 eligible neonates, 11 underwent patch repair and 10 received LR. Baseline characteristics between groups were comparable. The median follow-up was 391 days in the patch group and 215 days in the LR group (p = 0.1971). The LR group had significantly shorter median intubation duration, neonatal intensive care unit stay, and overall length of stay compared with the patch group (32.0 days vs. 43.0 days, p = 0.0445; 33.5 days vs. 66.0 days, p = 0.0309; 68.0 days vs. 97.0 days, p = 0.0435). There were no significant differences in recurrence rates, short-term complications, or motor developmental outcomes.LR appears to be associated with shorter hospital stays and faster recovery, without an increase in perioperative or long-term complications. While these findings suggest potential benefits of LR, they must be interpreted with caution due to the limited sample size. Further randomized, multicenter studies with larger cohorts, including long-term assessment of complications, are needed to confirm its efficacy and refine clinical guidelines.