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.
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.
