Our Summary

This research paper discusses two different surgical approaches for repairing a birth defect called congenital diaphragmatic hernia (CDH). The researchers wanted to see if one method, thoracotomy (going in through the chest), led to more repeat surgeries within the first year of life compared to the other method, laparotomy (going in through the abdomen).

They looked at records of babies who had these surgeries between 2000 and 2017, and compared the two groups. They found that babies who had the thoracotomy were more likely to need another surgery within the first year, mostly due to serious issues with their intestines. However, they didn’t find any difference between the two groups in terms of whether the hernia came back, whether they needed surgery for severe acid reflux, or in terms of how many babies died within the first year.

So, while both methods seem to have the same risk for the hernia coming back or for the baby dying, the chest entry method may lead to more problems with the intestines that require further surgeries.

FAQs

  1. What is a congenital diaphragmatic hernia (CDH) and how is it repaired?
  2. Does the thoracotomy method (going in through the chest) lead to more repeat surgeries within the first year than the laparotomy method (going through the abdomen)?
  3. Is there a difference in risk for the hernia recurrence or the baby dying, between the thoracotomy and laparotomy methods?

Doctor’s Tip

A helpful tip a doctor might give a patient about congenital diaphragmatic hernia repair is to discuss with the surgical team the best approach for their specific case. It is important to weigh the potential risks and benefits of each surgical method in order to make an informed decision about the best course of treatment for the baby. Additionally, close monitoring and follow-up care after surgery is crucial to ensure the best possible outcome for the baby.

Suitable For

Typically, patients who are recommended for congenital diaphragmatic hernia repair are infants who have been diagnosed with this birth defect. Congenital diaphragmatic hernia is a condition where there is a hole in the diaphragm that allows organs from the abdomen to move into the chest cavity, which can cause breathing difficulties and other complications.

Surgery is usually recommended for infants with congenital diaphragmatic hernia to repair the hole in the diaphragm and move the organs back into their correct position. The decision to recommend surgery is based on the severity of the hernia and the impact it is having on the baby’s breathing and overall health.

In this study, the researchers specifically looked at infants who had undergone surgery for congenital diaphragmatic hernia using either a thoracotomy or laparotomy approach. These surgeries are typically recommended for infants with significant diaphragmatic hernias that are causing breathing difficulties and other complications. The study aimed to compare the outcomes of these two surgical approaches to determine if one method was associated with a higher risk of complications or repeat surgeries within the first year of life.

Timeline

Before CDH repair:

  • Patient is diagnosed with congenital diaphragmatic hernia through ultrasound or other imaging tests during pregnancy
  • Patient may experience symptoms such as difficulty breathing, rapid breathing, and a rapid heart rate
  • Patient may undergo fetal intervention if CDH is severe enough
  • Patient is monitored closely by medical team to ensure baby’s health and growth before birth

After CDH repair:

  • Patient undergoes CDH repair surgery, either through thoracotomy or laparotomy, shortly after birth
  • Patient may need to stay in the neonatal intensive care unit (NICU) for monitoring and support after surgery
  • Patient may experience complications such as respiratory issues, feeding difficulties, or gastrointestinal issues
  • Patient may need additional surgeries within the first year, especially if thoracotomy method was used
  • Patient continues to be monitored closely by medical team for long-term health outcomes and potential complications of CDH repair.

What to Ask Your Doctor

Some questions a patient might consider asking their doctor about congenital diaphragmatic hernia repair include:

  1. What are the risks and benefits of each surgical approach (thoracotomy vs. laparotomy) for repairing CDH?
  2. How likely is it that my baby will need another surgery within the first year if they have the thoracotomy approach?
  3. What specific issues with the intestines might arise with the thoracotomy approach that could require additional surgeries?
  4. Are there any long-term implications or complications associated with either surgical approach?
  5. How experienced is the surgical team in performing CDH repair surgeries, and what is their success rate?
  6. Are there any alternative treatment options or techniques that could be considered for CDH repair?
  7. What is the expected recovery time and potential challenges my baby may face after surgery?
  8. How will the surgical approach chosen affect my baby’s quality of life in the long term?

Reference

Authors: De Bie F, Suply E, Verbelen T, Vanstraelen S, Debeer A, Cross K, Curry J, Coosemans W, Deprest J, De Coppi P, Decaluwé H. Journal: J Pediatr Surg. 2020 Oct;55(10):2105-2110. doi: 10.1016/j.jpedsurg.2019.12.020. Epub 2020 Jan 8. PMID: 32005504