Congenital Diaphragmatic Hernia
Mostly a left sided hernia, through a defect in the dome of the
diaphragm, pushing the abdominal viscera into the chest.
Problems
• Respiratory distress due
to lung compression
• Associated
ipsilateral lung hypoplasia
• Poorly
developed abdominal cavity.
Objectives
• Reduce the hernial contents
to abdomen
• Repair
the defect in the diaphragm
• Allow
slow expansion of the hypoplastic lung
• Increase
the space in the abdominal cavity.
Position
Supine with a folded towel under the lower chest.
Anesthesia
• General with
endotracheal intubation
• Face-mask
inhalation of gases-contraindicated.
Procedure
1. Subcostal incision 5-7 cm long and 1 cm below the costal margin.
2. Divide subcutaneous tissue and muscles with
cautery.
3. Open the peritoneum.
4. Reduce the contents (stomach, intestine, colon,
spleen) from the chest.
5. Retract left lobe of the liver medially.
6. Retract the stomach, intestine and spleen
inferiorly.
7. Identify the defect in the diaphragm.
8. Mobilize the edges of the defect.
9. Drain the left chest under water seal.
10. Suture the defect in 2 layers (double
breasting) with 4/0 silk.
11. Stretch the abdominal muscles, if required.
12. Avoid undue resistance to breathing.
Options
1. Gastrostomy for abdominal
decompression.
2. Marlex
mesh to repair the large defects of the diaphragm.
3. Creation
of a ventral hernia to prevent respiratory distress.
4. Elective
postoperative ventilation to assist in respiration.
Instruments
General pediatric set.
Special
• Red rubber catheter (#8) 1
• Under-water
seal bottle, tubes and 1
connector
connector
• Marlex
or prolene mesh.
Sutures
• 4/0 Catgut 1
• 4/0
Silk 2
• 4/0
Nylon 1
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