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Diaphragmatic hernia repair - congenital

Diaphragmatic hernia repair - congenital

Definition

Diaphragmatic hernia repair is surgery to correct an opening or tear in a baby's diaphragm. This opening is called a hernia. It is a rare type of birth defect. 

The diaphragm is a muscle. It is important for breathing. It separates the chest cavity (where your heart and lungs are) from the belly area.

In a child born with a diaphragmatic hernia, the organs from the belly (stomach, spleen, liver, and intestines) may go up into the chest cavity where the lungs are. This prevents the lung from growing normally. The lung stays too small for a baby to breathe on his or her own when they are born.

Description

Before this surgery, nearly all infants need a breathing device to improve their oxygen levels. 

The surgery is done while your child is under general anesthesia (asleep and not able to feel pain). The surgeon makes a cut in the belly under the upper ribs. This allows the organs in the area to be reached. The surgeon gently pulls these organs down into place through the opening in the diaphragm and into the abdominal cavity.

The surgeon repairs the hole in the diaphragm. If the hole is small, it may be repaired with stitches. In most cases, a piece of plastic patch is used to cover the hole.

Why the Procedure Is Performed

A diaphragmatic hernia can be life threatening. Surgery to repair it must be done in the first few days or weeks of a child’s life.

Risks

Risks for this surgery include:

Other possible complications of this surgery include:

  • Collapsed lung
  • Lung problems that do not go away
  • Respiratory failure

Before the Procedure

Infants with a diaphragmatic hernia are moved to a neonatal intensive care unit (NICU). It may be days or weeks before the baby is stable enough for surgery.

  • In the NICU, your baby will probably need a breathing machine (mechanical ventilator) before the surgery. This helps the baby breathe.
  • If your child is very sick, the doctor may use a heart-lung bypass machine (ECMO) to do the work of the heart and lungs.
  • Before surgery, your baby will have x-rays and regular blood tests to see how well your the lungs are working. A light sensor (called a pulse oximeter) is taped to baby's skin to monitor the oxygen level in the blood.
  • Your baby may be given medicines to control the blood pressure and keep him or her comfortable.

Your baby will have tubes placed:

  • In the mouth to the stomach to keep air out of the stomach
  • In an artery to monitor blood pressure
  • In a vein to deliver nutrients and medicines

After the Procedure

Your baby will stay in the hospital for several weeks after the surgery. Your baby will be on a breathing machine after the surgery. Once the baby is taken off the breathing machine, he or she may still need oxygen and some medicine for a while.

Feedings will start after your baby's bowels start working. Feedings are usually done through a feeding tube from the mouth into the stomach or small intestines until your baby can take all the food he or she needs by mouth.

Most infants with diaphragmatic hernias have reflux when they eat. This means the food or acid in their stomach moves up into their esophagus, the tube that leads from the throat to the stomach. This can be uncomfortable for your baby. It also leads to frequent spitting up, vomiting, and pneumonia, which makes feedings more difficult once your baby is taking food by mouth.

The nurses and feeding specialists will teach you ways to hold and feed your baby to prevent reflux. Some babies need to be on a feeding tube for a long time to get enough food to grow.

Outlook (Prognosis)

The outcome of this surgery depends on how well your baby's lungs have developed. Some babies have other medical problems, including problems with the brain, muscles, and joints, that may slow recovery.

Usually the outlook is good for infants who have well-developed lung tissue. Most babies with a diaphragmatic hernia from birth (congenital) are very ill and will stay in the hospital for a long time. With advances in medicine, the outlook for these infants is gradually improving.

All babies who have had diaphragmatic hernia repairs will need to be watched closely to make sure the hole in their diaphragm does not open up again as they grow.

Babies who had a large opening or defect in the diaphragm, or who had more problems with their lungs after birth, may have lung disease after they leave the hospital. They may need oxygen, medicines, and a feeding tube for months or years.

Some babies will have problems crawling, walking, talking, and eating. They will need to see physical or occupational therapists to help them develop muscles and strength.

References

Maheshwari A, Carlo WA. Diaphragmatic hernia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton, BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 95.8.

Puri P, Nakazawa N. Congenital diaphragmatic hernia. In: Puri P, Hollworth M, eds. Pediatric surgery: diagnosis and management. Springer; 2009:chap 31.


Review Date: 12/10/2012
Reviewed By: Shabir Bhimji MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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