Congenital diaphragmatic hernia surgery

Minimally invasive surgery has become the preferred method of treatment, which can be done thoracoscopically. Such techniques also lead to reduced postoperative pain and potential complications that may be seen with more invasive surgeries.

Unlike in the past, surgical repair is now delayed to at least 48 to 72 hours after birth. This allows the pulmonary vasculature to adapt and leads to the reduction of pulmonary hypertension. If ECMO is required, survival rates decrease by 50%.^[1]

• ECMO results in higher rates of bleeding related complications; this may be reduced by aminocaproic acid and modified anticoagulation use
  • Complications of ECMO: air embolism, intracranial hemorrhage, seizures, DIC, PDA (in an attempt to reduce pulmonary hypertension)^[2]

• Morgagni’s Hernia: In asymptomatic individuals laparoscopic surgical repair is still recommended as they are at risk of a strangulated intestine
• Diaphragm Eventration: Plication basically involves a folding of the eventrated diaphragm which is then sutured in order to “take up the slack” of the excess diaphragm tissue