WOFAPS 2025 8th World Congress of Pediatric Surgery

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Oral Presentation - 53

FETO and Outcomes in Congenital Diaphragmatic Hernia: Does the Prenatal Procedure Increase the Risk of Recurrence?

Nicoletta Nicolino 1, Giulia del Re 1, Emma Caforio 1, Ilaria Marcoccio 1, Giorgio R. Fava 1, Anna Morandi 1, Ernesto Leva 2
1 Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
2 Department of Clinical and Community Sciences, University of Milan, Milan

Background: Fetoscopic endoluminal tracheal occlusion (FETO) is known to improve survival in neonates with severe congenital diaphragmatic hernia (CDH). However, its potential association with an increased risk of hernia recurrence remains uncertain.

Objectives: To investigate a possible correlation between FETO and CDH recurrence.

Methods and Materials: Retrospective single-center study conducted on neonates who underwent surgical repair between 2012 and 2022. Data analyzed included FETO intervention, birth weight, defect size, and patch use. Patients with insufficient data were excluded. Subjects were divided into two cohorts: FETO vs. non-FETO, and recurrence rates were compared using Chi-square and Fisher’s exact tests.

Results: A total of 99 neonates met the inclusion criteria, 31 (31%) underwent FETO. The FETO group had a significantly lower mean birth weight (2499±540g vs. 3001±527g, p<0.001) and a higher prevalence of larger defects (types C and D: 84% vs 43%, p<0.001).

Overall, 24 patients (24%) experienced hernia recurrence, with no significant difference between FETO and non-FETO groups (29% vs. 22%, p=0.46). Recurrence was significantly associated with larger defect size (C + D: 59% vs. A + B: 10%, p<0.001). Of all the relapses, 2/15 were type A (13%), 5/29 type B (17%) both in non-FETO group (p=0.5); 7/26 were type C (27%), 1 FETO and 6 non-FETO (p=0.63), 10/29 type D (34%), 8 FETO and 2 non-FETO (p=0.4).

Patch repair was more common in the FETO group (84% vs 34%, p<0.001). Among the recurrences, 14 were repaired with patch (14/24, 58%), 8 FETO and 6 non-FETO (p=0.03).

Conclusion: no significant association between FETO and an increased recurrence rate was found. However, relapses were more frequent in larger defects - an established risk factor for recurrence - which were more prevalent in the FETO group. Further multicenter studies with larger cohorts could provide insight into the relationship between the two variables.

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