Dr. Mark Wulkan discusses recurrent and complicated congenital diaphragmatic hernia repairs. Dr. Wulkan's presentation includes insight of indications of these hernias, contraindications to MIS repair, pericostal suture, SIS underlay mesh, thoracoscopic congenital diaphragmatic hernia patch repair, and PTFE/biologic composite. Presentation of clinical cases generates discussion of systemic pulmonary pressures, VA versus VV ECMO, approaches to reoccurrences, and timing of CDH repair.