39541 Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic

Name of the Procedure:

Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic
Common Names: Diaphragmatic hernia repair, Chronic traumatic diaphragmatic hernia surgery

Summary

Diaphragmatic hernia repair is a surgical procedure aimed at correcting a hernia that has resulted from trauma, where part of the stomach or intestines moves into the chest cavity through an opening in the diaphragm. This condition is chronic, meaning it has been present for a long time.

Purpose

This procedure addresses the presence of a diaphragmatic hernia caused by traumatic injury. The goal is to reposition the organs back to their correct location in the abdomen and repair the diaphragm to restore normal function and prevent complications such as difficulty breathing or compromised organ function.

Indications

• Persistent pain or discomfort in the chest or abdomen.
• Difficulty breathing or shortness of breath.
• Diagnostic imaging confirming the presence of a diaphragmatic hernia.
• History of traumatic injury leading to the hernia.

Preparation

• Fasting for at least 8 hours before the procedure.
• Temporary adjustment or discontinuation of certain medications (e.g., blood thinners).
• Preoperative imaging studies such as CT scans or X-rays.
• Pre-surgical assessment including blood tests and a physical exam.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made either in the abdomen or chest, depending on the hernia's location and size.
3. The surgeon carefully repositions the stomach or intestines back into the abdominal cavity.
4. The diaphragm is then repaired using sutures or a mesh for reinforcement if needed.
5. The incision is closed with sutures or staples.
6. A drain may be placed to remove any excess fluid post-operation.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The procedure is usually performed in a hospital's surgical suite or operating room.

Personnel

• General Surgeon or Thoracic Surgeon
• Anesthesiologist
• Surgical nurses and support staff

Risks and Complications

• Common: Infection, bleeding, pain at the incision site.
• Rare: Organ injury, respiratory complications, recurrence of the hernia, adverse reaction to anesthesia.

Benefits

• Relief from symptoms like pain and difficulty breathing.
• Prevention of further complications such as organ strangulation.
• Improvement in overall quality of life. Expected benefits can usually be noticed within several weeks following the procedure.

Recovery

• Post-operative hospital stay of 3 to 7 days.
• Pain management with prescribed medications.
• Instructions for wound care and activity restrictions.
• Follow-up appointments for monitoring recovery and removing sutures or staples.
• Full recovery typically takes 6 to 8 weeks.

Alternatives

• Watchful waiting (in cases with minimal symptoms).
• Non-surgical management such as physical therapy to relieve symptoms.
• Pros: Lower immediate risk without surgery.
• Cons: Might not fully address the hernia, risk of symptoms worsening over time.

Patient Experience

• The patient will be asleep and not feel pain during the procedure due to general anesthesia.
• Post-operative pain and discomfort are managed with medication.
• Gradual return to normal activities after several weeks, with full activity resuming as healing permits.