Diaphragmatic hernia repair�is surgery to correct a birth defect in which the diaphragm, the large�dome-shaped muscle that separates the chest cavity from the abdomen, fails to completely develop.
When the abdominal organs pass into the chest cavity, the lung tissue on the affected side is compressed, fails to grow normally, and is unable to expand after birth. As the child begins to breathe, cry and swallow, air enters the intestines that are protruding into the chest. The increasing size of the intestines puts pressure on the other side of the chest, the other lung and the heart and can quickly cause a life-threatening situation.
A diaphragmatic hernia requires immediate surgery.
Causes
As a fetus is growing in its mother's uterus before birth, different organ systems are developing and maturing. The diaphragm forms between the 7th and 10th week of pregnancy. The esophagus (the tube that leads from the throat to the stomach), the stomach and the intestines are also developing at this time.
In a�Bochdalek hernia, the diaphragm may not develop properly, or the intestine may become trapped in the chest cavity as the diaphragm is forming.
In a�Morgagni hernia, the tendon that should develop in the middle of the diaphragm does not develop properly.
In both cases, normal development of the diaphragm and the digestive tract does not occur.
Diaphragmatic hernia is a multifactorial condition, which means that "many factors," both genetic and environmental, are involved. It is thought that multiple genes from both parents, as well as a number of environmental factors that scientists do not yet fully understand, contribute to diaphragmatic hernia. In cases where it is the only health problem in a baby, the chance for diaphragmatic hernia to happen again in a future pregnancy is two percent or 2 in 100 chances. This means that there is a 98 percent chance that it would not be seen in a future pregnancy.
Symptoms
The indications for a�diaphragmatic hernia repair�include the following:
Chest x-rays showing diaphragmatic hernia
Severe breathing difficulty (respiratory distress) shortly after birth
Prenatal ultrasound often identifies a diaphragmatic hernia
BRIEF ABOUT THE PROCEDURE
This procedure is done under General anesthesia. �A suitable incision is made in the upper abdomen, under the ribs. The abdominal organs are gently pulled down through the opening in the diaphragm and positioned into the abdominal cavity.
The hole in the diaphragm is repaired and the incision is sutures. If a large defect is present, a plastic patch is used to cover the defect in the diaphragm. A tube is placed in the chest to allow air, blood and fluid to drain so the affected lung can re-expand. This tube remains in place after surgery for a few days.
SOME ASSOCIATED RISKS
Risks for any surgery include bleeding and infection.
Bleeding
Infection
Possible complications may include a Collapsed lung (pneumothorax) or failure of the affected lung to expand or mature.
Diaphragmatic hernia is a life-threatening condition that requires surgery as soon as symptoms develop, usually in the first 24 hours of life. The outcome depends on the lung on the affected side.
Most babies require ventilator support (the use of a machine to help them breathe) after surgery. Generally the prognosis is very good for infants with adequate lung tissue.
TIPS ON RECOVERY
Babies may require several weeks of hospitalization after surgery depending on how long breathing needs to be supported with a machine. Feeding is begun after the first bowel movement is passed. Feeding is usually done through a tube into the stomach or small intestines until the breathing tubes are removed.
DESTINATIONS FOR LAPAROSCOPY REPAIR OF DIAPHRAGMATIC HERNIA
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