Diaphragmatic hernia repair - congenital

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The diaphragm is a large dome-shaped muscle that separates the chest cavity (where your heart and lungs are) from the belly area. The diaphragm is a very important muscle for breathing.

A diaphragmatic hernia is an opening or tear in the diaphragm. Diaphragmatic hernias in babies are very rare and occur in one out of every 4,000 births.

In a child born with a diaphragmatic hernia, the organs from the belly (stomach, spleen, liver, and intestines) may go up into the chest cavity where the lungs are. These abdominal organs take up the space and prevent the lung from growing normally. The result is that the lung remains too small for children to breathe on their own when they are born. Diaphragmatic hernia repair is surgery to correct this birth defect.

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Surgery is done while your child is under general anesthesia (asleep and not able to feel pain). The surgeon makes a surgical cut in the abdomen under the upper ribs to be able to reach the organs of the abdomen. Then the surgeon gently pulls these organs down into place through the opening in the diaphragm and into the abdominal cavity.

The surgeon repairs the hole in the diaphragm. If the hole is small, it may be repaired with stitches, but in most cases a piece of plastic patch is used to cover the hole in the diaphragm.

After surgery, a tube from the chest will remain in place for a few days to allow air, blood, and fluid to drain. The increased room in the chest will now allow the lungs room to expand.

A diaphragmatic hernia can be life threatening. Surgery to repair it must be done in the first few days or weeks of a child’s life.

Most infants with a diaphragmatic hernia are transferred to a neonatal intensive care unit (NICU). It may take days or weeks for your child's health to be stable enough for surgery.

• In the NICU, your child will probably need help breathing with a breathing machine (mechanical ventilator) before the surgery. This is because the lungs are smaller than normal.
• If your child is very sick, their doctor may use a heart-lung bypass machine to help the child get well enough for surgery. This machine does the work of the heart and lungs for your child.
• Before surgery, the hospital staff will take many x-rays and perform regular blood tests to see how well your child's lungs are working. Your child will also have a light sensor (called a pulse oximeter) taped to the skin to monitor the oxygen level in the blood.
• Your child may also be on medicines to control the blood pressure and keep him or her comfortable.