About the repair surgery

I found this on the CHERUBS website. Its the American Pediatric Surgical Association's description of what will happen to Maddie immediately after birth and leading up to her repair surgery. I just copied the text over, but if you want to see the diagrams, click here:
http://www.cdhsupport.org/apsacdh.php




Before Surgery

All newborns with CDH require surgery; however, the timing of the operation may be different for different babies. In the past, people thought that the babies needed an operation immediately, but it now looks like that is not necessary.

The operation may make the lungs worse because it can put The operation may make the lungs worse because it can put pressure on the good lung. This is usually a problem for just a short time. Before surgery, the baby will usually have a tube going into the stomach and catheters in an artery and vein. The infant will be on a mechanical ventilator and most hospitals will try to keep the amount of pressure on the lungs from the ventilator as low as possible. This is to avoid injuring the very small lungs.

Before surgery, the baby will have a tube in the stomach to keep air out of the intestines and to keep the intestines from pressing on the lungs. The amount of oxygen in the baby’s blood will be watched constantly, usually with a device (pulse oximeter) on the hand or foot. The baby may need medicines to keep the blood pressure normal. In some hospitals, the baby may have a different ventilator that works very fast to breathe for the infant (a high frequency ventilator).

If the baby does not keep the blood oxygen level high enough with these devices, heart lung bypass (ECMO) may be used for several days to weeks. This can only be done in very specialized centers and the infant may be transferred to a center that does ECMO.

The baby will usually have surgery after the situation is stable. It may be days or weeks before an operation is done. If the baby is on ECMO, the infant may have the surgery while on the ECMO machine. The operation may make the lungs worse initially. This is because the intestines are put back into the abdomen and cause pressure on the lungs from below.


Surgical Technique

The CDH is usually fixed by making an incision in the abdomen just below the rib cage. Sometimes, a separate incision in the chest is needed, but if needed, it is usually in babies with a hernia on the right side. The first step is to move the intestines into the abdomen (Figure 4).

After this is done, the edges of the diaphragm are found. If they can be sewn together, they will be (Figures 5, 6, 7). Sometimes, the hole is too large. If this is the case, an artificial patch (such as Gore-Tex) may be used to close the hole (Figure 8 and 9). If, after fixing the hole, there is not enough room in the abdomen for the intestines, another patch may be placed on the abdomen to hold the intestines until the swelling gets better.

The best time for the operation is still debated, but currently most surgeons wait until the baby does not need a lot of help from the ventilator. As mentioned, this can sometimes take days or weeks.