Our Summary

The study looked at past cases of neonates (newborns) who had a type of surgery called thoracoscopic repair for a birth defect known as congenital diaphragmatic hernia (CDH). The defect happens when the diaphragm, the muscle that separates the chest from the abdomen, does not fully develop, allowing the intestines and other organs to move into the chest.

The researchers analyzed data from 109 infants who had this surgery between 2009 and 2015 to see how successful it was and what factors might be associated with the hernia recurring (coming back). They found that the hernia recurred in 8.4% of babies who had the surgery.

The study found that the surgery was feasible and could be done successfully in carefully chosen patients. However, some factors were associated with a higher chance of the hernia recurring, including babies who needed medicine to raise their blood pressure (vasopressor therapy), those who were on a certain type of breathing machine (high-frequency oscillatory ventilation or HFOV), and those with the spleen in the chest.

The researchers concluded that there is currently no one-size-fits-all approach to this surgery and more research is needed.

FAQs

  1. What is a congenital diaphragmatic hernia?
  2. What factors were found to increase the chance of the hernia recurring after surgery?
  3. What was the recurrence rate of the hernia in babies who had the thoracoscopic repair surgery?

Doctor’s Tip

When discussing congenital diaphragmatic hernia repair with a doctor, they may advise the patient to carefully monitor their baby’s health post-surgery. They may suggest keeping an eye out for any signs of the hernia recurring, such as difficulty breathing, vomiting, or a swollen abdomen. It’s important to follow up with regular appointments and communicate any concerns with the medical team. Additionally, the doctor may recommend avoiding activities that could put strain on the abdominal muscles, such as lifting heavy objects, to help prevent the hernia from returning.

Suitable For

Overall, patients who are typically recommended congenital diaphragmatic hernia repair are newborns with a confirmed diagnosis of CDH. The surgery is usually recommended for those with severe symptoms or complications related to the hernia, such as respiratory distress, difficulty feeding, or failure to thrive. Patients who are stable enough to undergo surgery and do not have any significant comorbidities are typically considered good candidates for repair. It is important for the surgical team to carefully assess each individual case and consider factors such as the size and location of the hernia, the presence of other organ involvement, and the overall health and stability of the patient before recommending surgery.

Timeline

-Before CDH repair:

  1. Diagnosis of congenital diaphragmatic hernia through prenatal ultrasound or shortly after birth.
  2. Monitoring of the baby’s condition and possible complications such as breathing difficulties, feeding issues, and gastrointestinal problems.
  3. Evaluation of the baby’s overall health and readiness for surgery.
  4. Consultation with a multidisciplinary team of healthcare providers to discuss treatment options and surgical intervention.

-After CDH repair:

  1. Post-operative recovery period in the hospital, including monitoring for any complications such as infection, respiratory issues, or recurrence of the hernia.
  2. Gradual improvement in the baby’s breathing, feeding, and overall health.
  3. Follow-up appointments with healthcare providers to monitor the baby’s progress and address any long-term effects of the surgery.
  4. Continued monitoring and support for the baby’s development and growth.

What to Ask Your Doctor

Some questions a patient should ask their doctor about congenital diaphragmatic hernia repair include:

  1. What are the risks and benefits of thoracoscopic repair for congenital diaphragmatic hernia in my case?
  2. What criteria do you use to determine if I am a suitable candidate for this surgery?
  3. What factors increase the risk of the hernia recurring after surgery, and how will you mitigate these risks in my case?
  4. How often do you perform this type of surgery, and what is your success rate?
  5. What alternative treatment options are available for congenital diaphragmatic hernia, and why do you recommend thoracoscopic repair for me?
  6. What is the typical recovery process and timeline following thoracoscopic repair for congenital diaphragmatic hernia?
  7. Will I need any additional treatments or therapies after the surgery, such as physical therapy or medication?
  8. How often will I need follow-up appointments to monitor my progress and check for any potential complications?
  9. Are there any long-term effects or complications associated with thoracoscopic repair for congenital diaphragmatic hernia that I should be aware of?
  10. Are there any lifestyle changes or precautions I should take after the surgery to help prevent the hernia from recurring?

Reference

Authors: Weaver KL, Baerg JE, Okawada M, Miyano G, Barsness KA, Lacher M, Gonzalez DO, Minneci PC, Perger L, St Peter SD. Journal: J Laparoendosc Adv Surg Tech A. 2016 Oct;26(10):825-830. doi: 10.1089/lap.2016.0358. Epub 2016 Sep 7. PMID: 27603706