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Diaphragmatic hernia repair - congenital

Definition

Diaphragmatic hernia repair is surgery to correct a birth defect in which the diaphragm, the large dome-shaped muscle that separates the chest cavity from the abdomen, fails to completely develop.

A diaphragmatic hernia requires immediate surgery.

Description

While the child is under general anesthesia, a cut is made in the upper abdomen, under the ribs. The abdominal organs are gently pulled down through the opening in the diaphragm and positioned into the abdominal cavity.

The hole in the diaphragm is repaired and the cut is stitched closed. If a large defect is present, a plastic patch is used to cover the defect in the diaphragm. A tube is placed in the chest to allow air, blood, and fluid to drain so the affected lung can re-expand. This tube remains in place after surgery for a few days.

Why the Procedure is Performed

When the abdominal organs pass into the chest cavity, the lung tissue on the affected side is compressed, fails to grow normally, and is unable to expand after birth. As the child begins to breathe, cry, and swallow, air enters the intestines that are protruding into the chest. The increasing size of the intestines puts pressure on the other side of the chest, the other lung, and the heart and can quickly cause a life-threatening situation.

The indications for a diaphragmatic hernia repair include the following:

• Chest x-rays showing diaphragmatic hernia
• Severe breathing difficulty (respiratory distress) shortly after birth
• Prenatal ultrasound often identifies a diaphragmatic hernia

Risks

Risks for any anesthesia include the following:

• Reactions to medications
• Problems breathing

• Bleeding
• Infection

• Collapsed lung (pneumothorax)
• Failure of the affected lung to expand or mature

Outlook (Prognosis)

Diaphragmatic hernia is a life-threatening condition that requires surgery as soon as symptoms develop, usually in the first 24 hours of life. The outcome depends on the lung development on the affected side.

Most babies require ventilator support (the use of a machine to help them breathe) after surgery. Generally the prognosis is very good for infants with adequate lung tissue.

Recovery

Babies may require several weeks of hospitalization after surgery depending on how long breathing needs to be supported with a machine. Feeding is begun after the first bowel movement is passed. Feeding is usually done through a tube into the stomach or small intestines until the breathing tube is removed.

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