Health Encyclopedia

Diaphragmatic hernia repair - congenital

Definition

Diaphragmatic hernia repair is surgery to correct a birth defect in which the diaphragm fails to completely develop. The diaphragm is the large dome-shaped muscle that separates the chest cavity from the belly area. The birth defect allows abdominal organs such as the stomach, small intestine, spleen, liver, and kidneys to move into the chest cavity. As a result, lung tissue does not develop completely.

A diaphragmatic hernia requires surgery.

Description

A child with this condition may use a breathing machine for hours, days, or weeks before having surgery.

Before surgery, the child will be placed under general anesthesia (asleep, no pain). The surgeon makes a cut in the upper abdomen under the ribs. The abdominal organs are gently pulled down through the opening in the diaphragm and placed into the abdominal cavity.

The surgeon repairs the hole in the diaphragm and stitches the cut closed. A plastic patch is used to cover large defects.

After surgery, a tube will remain in place for a few days to allow air, blood, and fluid to drain. This allows the affected lung to re-expand.

If a diaphragmatic hernia is diagnosed during pregnancy (around 24 - 28 weeks), fetal surgery may be considered.

Indications

A diaphragmatic hernia can be a life-threatening situation and requires immediate surgery.

Risks

Risks for any anesthesia include:

Breathing problems
Reactions to medications

Risks for any surgery include:

Bleeding
Infection

Other possible complications specific to this surgery include:

Collapsed lung
Lung problems that continue

Expectations after surgery

Most babies need a breathing machine after surgery. The outcome depends on how well the baby's lung has developed. Generally the outlook is very good for infants with adequate lung tissue.

Convalescence

Babies may to stay in the hospital for several weeks after surgery. The length of the hospital stay depends on the severity of the hernia and how long a breathing machine is needed.

Feeding will start 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.

References

Dudell GG, Stoll BJ. Respiratory tract disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 101.

Review Date:8/13/2008
Reviewed By:A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Deirdre O’Reilly, MD, MPH, Neonatologist, Division of Newborn Medicine, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts (11/2/2007).

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