Congenital Diaphragmatic Hernia Repair

Introduction

Congenital diaphragmatic hernia (CDH) is a rare birth defect in which an opening to the diaphragm allows abdominal organs to emerge in the pleural space. This syndrome interrupts lung formation, causing formidable pulmonary impairment at birth. Congenital diaphragmatic hernia repair is a surgical intervention to suture the diaphragmatic defect to restore normal anatomy and improve the newborns’ chances to live a healthy life.

Modern developments in neonatal care and surgical procedures have led to dramatically increased survival for infants born with CDH. In India, world-class pediatric surgeons and facilities are providing optimal results for this intricate condition.

What is Congenital Diaphragmatic Hernia Repair?

Diaphragm repair is a surgical intervention designed to repair the defect of the diaphragm. Surgery consists of the relocation of the displaced abdominal organs in the abdominal cavity and the closure of the diaphragm defect by sutures or synthetic patches. This repair helps the lungs expand properly, improving breathing and overall health.

CDH is commonly seen during prenatal ultrasound, and this can be used by parents and medical staff to prepare for postnatally interventional procedures.

Why is Congenital Diaphragmatic Hernia Repair Needed?

CDH repair is necessary to: 

• Restore Normal Anatomy: Returns displaced abdominal organs to their proper position.
• Facilitate Lung Development: Makes room in the chest for the lungs to expand and work.
• Improve Breathing: Reduces respiratory distress caused by underdeveloped lungs.
• Prevent Complications: Reduces the risk of infection, pulmonary hypertension, and gastrointestinal problems.
• Enhance Survival: Early surgical intervention can help enhance survival and long-term well-being.

Types of Congenital Diaphragmatic Hernia

Bochdalek Hernia:

• The most frequent form involves the posterior and lateral costae of the diaphragm.
• Often involves the stomach, intestines, spleen, and liver.

Morgagni Hernia:

• Less common is located at the front of the diaphragm.
• Typically involves the liver and intestines.

Central Diaphragmatic Hernia:

• A very uncommon subtype with a diaphragmatic defect in the central region.

Procedure Steps

1. Pre-Surgery Preparation:

• Prenatal Diagnosis: Ultrasound or MRI to confirm the diagnosis and assess lung development.
• Stabilization at Birth: Acute care in the neonatal intensive care unit (NICU) to address respiratory distress.
• Pre-Surgical Support: Use of the ventilator or extracorporeal membrane oxygenation (ECMO) to stabilize the delivery baby before operation.

2. Anesthesia:

• General anesthesia is used to make the baby sleep well without any pain during the procedure.

3. Surgical Process:

• • Incision: A small incision is made in the baby’s abdomen or chest, depending on the hernia’s location.
  • Organ Repositioning: The surgeon positioned displaced structures back into the abdominal cavity.

• Diaphragm Repair:

• • Small defects are stitched closed.
  • Sites of larger defects may benefit from a synthetic patch to reinforce the diaphragm.

• Chest Drain
  • Chest drainage may be carried out using a chest tube to remove excess fluid and expand the lung.

4. Closure and Monitoring: 

• The incision is sutured and the infant is closely watched in the NICU.

Benefits of Congenital Diaphragmatic Hernia Repair

• Improved Breathing: This creates space for the lungs to expand and function.
• Reduced Pulmonary Hypertension: Lowers pressure in the lungs, improving oxygenation.
• Restored Organ Function: Returns displaced organs to their proper positions.
• Enhanced Survival Rates: Recent progress in surgical and neonatal care has dramatically enhanced the results.
• Better Quality of Life: Enables normal growth and development in most cases.

Cost of Congenital Diaphragmatic Hernia Repair

• United States: $20,000 – $50,000 
• United Kingdom: $15,000 – $40,000 
• Thailand: $6,000 – $12,000 
• India: $4,000 – $10,000 

Best Hospitals in India for Congenital Diaphragmatic Hernia Repair

India has outstanding hospitals with expertise in pediatric and neonatal surgeries. Notable facilities include:

Metro Hospital Faridabad: 

• Renowned for advanced neonatal care and pediatric surgery.
• Offers state-of-the-art facilities and skilled surgeons.

Fortis Healthcare (Delhi): 

• Known for comprehensive neonatal and pediatric services.
• High success rates in complex congenital surgeries.

Max Healthcare (Delhi):

• Offers state-of-the-art technology and a combined approach in CDH repair.

Risks and Complications

While CDH repair is life-saving, potential risks include:

• Infection: preventable with proper postoperative care.
• Bleeding: Managed with advanced surgical techniques.
• Lung Complications: Persistent pulmonary hypertension or underdeveloped lungs.
• Recurrence: Rare but possible, requiring additional intervention.
• Digestive Issues: Temporary feeding difficulties post-surgery.

Recovery

Immediate Recovery:

• NICU Stay: Infants continue to be in the NICU for weeks to adjust breathing and to track progress.
• Ventilation Support: There may be some infants who continue to need ventilators or ECMO postoperatively.

Long-Term Recovery:

• 3-6 Months: Most babies show significant improvement in breathing and feeding.
• Follow-Up Care: Routine visits with a pediatric surgeon and with a pulmonologist to check growth, lung function, and overall status.
• Developmental Support: Physical and occupational therapy may be indicated to manage developmental delays.