Congenital Diaphragmatic Hernia Surgery
Diaphragmatic hernia surgery is typically performed using general anesthesia and is done on an inpatient basis. It may be performed emergently, immediately after the birth of the child, or as soon as the child is stable enough to tolerate surgery. In some cases, there may be a need to stabilize the child’s breathing or heart function before surgery can be done. In very rare circumstances, surgery in utero may be considered, a procedure where surgery is performed on the fetus while the mother is pregnant. The fetus is then allowed to continue developing while the pregnancy continues, although the pregnancy becomes very high risk.
The surgery, when performed on a newborn, is done by a pediatric general surgeon, but may require the assistance of other surgeons, such as acardiothoracic surgeon or a colon-rectal specialist in severe cases. Depending upon the organs affected, different or additional surgeons with varying expertise may participate in the surgery.
The surgery is usually performed with an open approach using a standard incision just below the rib cage, rather than the less invasive laparoscopic method. This is due to the severity of the problem combined with the very small size of the patient.
The surgery begins with locating the defect in the diaphragm and the tissue that has pushed in to the chest area. The tissue and organs, if present, are placed back in the abdomen. Once the tissues are returned to their proper place, the hole in the diaphragm is closed. This is done to prevent the abdominal tissues from migrating back in to the chest cavity. If the defect in the diaphragm is very severe, a diaphragm may be created from synthetic materials.