39503 Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

Name of the Procedure:

Repair of Neonatal Diaphragmatic Hernia (with or without Chest Tube Insertion and with or without Creation of Ventral Hernia)
Common Names: CDH Repair, Congenital Diaphragmatic Hernia Repair

Summary

This surgical procedure involves correcting a defect in a newborn's diaphragm, which can cause abdominal organs to move into the chest cavity, impacting lung development. The surgery may include inserting a chest tube for drainage and might involve creating a ventral hernia depending on the severity of the case.

Purpose

The procedure addresses congenital diaphragmatic hernia, a condition where the diaphragm does not form properly, leading to breathing difficulties and other complications. The goal is to repair the diaphragm and ensure proper lung function and positioning of abdominal organs.

Indications

• Newborn diagnosed with congenital diaphragmatic hernia.
• Respiratory distress due to improper lung development.

• Abdominal organs seen in the chest cavity on imaging studies.

  Preparation

• Fasting before surgery as per doctor's instructions.
• Adjustment or cessation of certain medications.
• Preoperative imaging and assessments, such as ultrasounds or MRIs, to determine the extent of the hernia.
• Discussing the procedure and its risks with the parents or guardians.

Procedure Description

1. General anesthesia is administered to the newborn.
2. An incision is made in the abdomen or chest, depending on the hernia's location.
3. The surgeon gently moves displaced abdominal organs back into the abdominal cavity.
4. The diaphragm defect is repaired using sutures or a synthetic patch.
5. A chest tube may be inserted to drain excess air or fluids from the chest cavity.
6. In some cases, a ventral hernia might be created to facilitate the procedure and organ placement.
7. The incision is closed, and the baby is monitored in an intensive care setting.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the hernia and the extent of the repair needed.

Setting

The surgery is performed in a hospital, typically in a specialized pediatric surgical center or neonatal intensive care unit (NICU).

Personnel

• Pediatric surgeon
• Anesthesiologist
• Surgical nurses
• Neonatologist

Risks and Complications

• Common: Infection, bleeding, reactions to anesthesia
• Rare: Recurrence of the hernia, damage to surrounding organs, prolonged respiratory issues

Benefits

• Improved lung function and development
• Proper placement of abdominal organs
• Increased chances of normal breathing and feeding

Recovery

• Intensive care monitoring post-surgery
• Pain management with medications
• Gradual reintroduction of feeding
• Close follow-up appointments to monitor progress and identify any complications

Alternatives

• Delayed surgery with intensive care support until the baby is stronger
• Non-surgical management for less severe cases
• Long-term mechanical ventilation and supportive therapies.

Patient Experience

During the procedure, the newborn will be under anesthesia and feel no pain. Post-surgery, the child may experience discomfort, which will be managed with pain relief medications. Parents can expect a hospital stay of several weeks to months, depending on the baby's recovery and overall health. Regular follow-ups and monitoring are crucial for ensuring successful long-term outcomes.