Congenital Diaphragmatic Hernia surgery

Congenital Diaphragmatic Hernia surgery is a type of surgery that is performed to close the defect in a baby with CDH.

June 1, 2022

Congenital Diaphragmatic Hernia surgery is a type of surgery that is performed to close the defect in a baby with CDH.

Some facts about Congenital Diaphragmatic Hernia surgery:

  • Congenital diaphragmatic hernia (CDH) occurs when there is a hole in the diaphragm.
  • The lungs is separated from the contents of the abdomen by a muscular sheet called diaphragm whose main function is to help in respiration.
  • The diaphragm moves down during breathing and creates a negative suction pressure in the chest to suck the air from the atmosphere into the lungs.
  • The diaphragm can have a defect or a hole due to various reasons.
  • The contents of the abdominal cavity can migrate up into the chest and lie there through this hole. As a result of this, the effective expansion and breathing of lungs will be prevented due to compression of the lungs on that side which is is referred to as a diaphragmatic hernia.
  • Congenital Hernia is an incomplete formation diaphragm during birth.
  • Mostly CDH occurs on the left side.
  • The bowel, stomach or even the liver can move into the chest cavity when this gap forms during a fetus's development in the womb.
  • The herniation of the abdominal organs including the stomach, intestine, liver, spleen, or kidney into the chest occupies that space and prevents the lungs from growing to normal size.
  • It is called pulmonary hypoplasia when he growth of both lungs are affected.
  • All infants need a breathing machine to improve their oxygen levels untill the surgery is done, and usually for some time afterwards.
  • An extracorporeal membrane oxygenation (ECMO) is required in many babies with CDH, in which a pump is used to circulate blood through an artificial lung and back into the bloodstream of the baby.

Procedure for Congenital Diaphragmatic Hernia surgery:

  • Small diaphragmatic hernias do not require any treatment which don't cause any symptoms.
  • Congenital Diaphragmatic Hernia surgery is usually performed after the baby has stabilized in the first week of life.
  • The hernia will be repaired based on the severity and exact location of the hernia
  • The surgery will be done while your child is under general anesthesia so that he/she will not be able to feel pain.
  • The hole can be sewn closed if the opening in the diaphragm is small and the amount of diaphragmatic muscle is adequate.
  • The surgeon will require additional tissue or material to close the defect if the opening in the diaphragm is large or a significant portion of the diaphragm is absent.
  • A patch repair will be done by using a synthetic biocompatible material to patch the opening
  • A cut (incision) in the belly under the upper ribs will be made by the surgeon which allows the organs in the area to be reached.
  • These organs will be pulled down gently into place through the opening in the diaphragm and into the abdominal cavity.
  • The surgery can also be done using smaller incisions in the chest in few cases.
  • Thoracoscope is a small video camera that is placed through one of the incisions which allows the surgeon to view inside the chest.
  • Other incisions are used to place the instruments to repair the hole in the diaphragm.
  • The hole in the diaphragm can be repaired by both the procedure.
  • It may be repaired with stitches if the hole is small, else an artificial patch is used to cover the hole.
  • These babies will need intensive support for many weeks or even months after the surgery.