Reviewed By Neil K. Kaneshiro MD, MHA, Clinical Assistant Professor of Pediatrics, University of Wash…ington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.more »
Definition
The diaphragm is a large dome-shaped muscle that separates the chest cavity (where your heart and lungs are) from the belly area. A diaphragmatic hernia is an opening or tear in the diaphragm.
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 organs take up the space, the lungs need to grow. The result is that the lungs are too small for your child to breathe on their own when they are born. Diaphragmatic hernia repair is surgery to correct this birth defect.
Description
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, and a plastic patch may be used to cover the hole in the diaphragm also. Stitches are used to close the surgical cut
After surgery, a tube from the chest will remain in place for a few days to allow air, blood, and fluid to drain from your child’s abdomen. This gives the lungs room to expand.
Why the Procedure Is Performed
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.
In the NICU, your child will probably need help breathing with a breathing machine (mechanical ventilator) before the surgery. This is because their lungs are smaller than normal.
If your child is very sick, their doctor may use a heart-lung bypass machine to help them get well enough for surgery. This machine does the work of the heart and lungs for your child.
Before surgery, the hospital staff will be taking many x-rays and doing many 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 their skin to monitor the oxygen level in their blood.
Your child may also be on medicines to control their blood pressure and keep them comfortable.
Your child will also have a tube going from their mouth to their stomach to keep air out of the stomach. They will also have a catheter (tube) placed in an artery and a vein to deliver nutrients and medicines, and so that their blood can be monitored.
After the Procedure
Your child will stay in the hospital for several days to weeks after the surgery. Your child will be on a breathing machine after the surgery. Once they are taken off the breathing machine, they will still need oxygen and some medicine for a while.
Feedings will start after your child’s bowels start working. Feedings are usually done through a feeding tube from the mouth into the stomach or small intestines until your child can take all the food they need by mouth.
Most infants with diaphragmatic hernias have reflux when they eat. This means the food in their stomach moves up into their esophagus (the tube that leads from the throat to the stomach). This can be painful for your child. It also leads to frequent spitting up, which makes feedings more difficult once your child is taking food by mouth.
The nurses and feeding specialists will help you learn the best way to feed your baby. Some children need to be on a feeding tube for a long time to get enough food to grow.
Outlook (Prognosis)
The outcome of this surgery depends on how well your baby's lungs have developed. Usually the outlook is very good for infants who have enough lung tissue.
All children who have had diaphragmatic hernia repairs will need to be watched closely to make sure the hole in their diaphragm does not open up again as they grow.
Children who had a large opening or defect in the diaphragm, or who had more problems with their lungs after birth, may have ongoing lung disease after they leave the hospital. They may need oxygen, medicines, and a feeding tube for months or years.
Some children will have problems crawling, walking, talking, and eating. They will need to see physical or occupational therapists to help them develop muscles and strength.
References
Ehrlich PF, Coran AG. Diaphragmatic hernia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 101.
