Congenital diaphragmatic hernia repair
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MEDICAL ANIMATION TRANSCRIPT: A congenital diaphragmatic hernia is a birth defect in which a normal opening in a baby's diaphragm allows abdominal organs to move into the chest. The diaphragm is a broad, concave sheet of muscle that separates the chest from the abdomen. When a baby inhales, the diaphragm and external intercostal muscles contract, expanding the chest cavity. This expansion lowers the air pressure inside the chest and creates a pressure change that forces air rushing into the lungs. When the baby exhales, the diaphragm relaxes and the internal intercostal muscles contract, reducing the size of the chest cavity. This reduced size increases the air pressure inside the chest and forces air out of the lungs. For unknown reasons, in some babies, the diaphragm does not fully develop before birth, resulting in an opening between the chest and abdomen. The most common location for this opening is on the left side of the diaphragm, near the back. The baby's abdominal organs can pass through, or herniate, through this opening in the diaphragm and compress the lungs. As a result, the lungs do not fully develop, causing the baby significant breathing difficulty right after birth. Before the operation, the baby will be given general anesthesia to ensure they are asleep throughout the procedure. An endotracheal tube, inserted immediately after birth through the nose or mouth and down the throat, will continue to assist the baby's breathing during the operation. Typically, the surgeon will make an incision below the ribs on the left side. The surgeon will then carefully move the abdominal organs from the back of the chest into their normal position in the abdomen. If the hole in the diaphragm is small, it will be closed with sutures only. If the hole is too large or there isn't enough muscle to close it, the surgeon will sew a patch over it. Finally, the surgeon will close the incision with dissolvable sutures or bandages with adhesive tape. After the procedure, the baby will be taken to the neonatal intensive care unit (NICU) for monitoring. A mechanical ventilator will help the baby breathe for a few days or several weeks. Pain medication will be given. The baby may continue to receive antibiotics intravenously. The hospital stay can last weeks or months, depending on the size and condition of the baby's lungs. If a patch was used, the baby's growth will need to be closely monitored because the patch does not grow and may begin to detach from the hole.
ANH13090es