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Diaphragmatic Hernia Repair

What is diaphragmatic hernia?

The diaphragm is a muscular sheet which separates the lungs from the contents of the abdomen.The main function of this sheet is to help in respiration.Just like the plunger in a syringe, the diaphragm moves down during breathing and creates a negative suction pressure in the chest.This action sucks the air from the atmosphere into the lungs.
Due to various reasons, this muscular sheet can have a defect or a hole.Through this hole, the contents of the abdominal cavity can migrate up into the chest and lie there.This causes compression of the lungs on that side thereby preventing its effective expansion and breathing.This condition is referred to as diaphragmatic hernia.

Causes of Diaphragmatic hernia

A diaphragmatic hernia is an uncommon condition.Most commonly the defect occurs because of a developmental problem when the child is in the womb of the mother.The children are born with this defect.Many times this is diagnosed immediately after birth when a hernia is large and the child develops breathing difficulty.Sometimes this problem can go unnoticed until adulthood when it is diagnosed by an X-ray did routinely for some other problem. 
This problem can also arise due to other reasons like trauma, obesity and as a result of some surgeries.

What are the symptoms of  diaphragmatic hernia?

The most common symptoms are difficulty in breathing.This can occur during rest when a hernia is very big.In moderate size hernias, the patient might experience breathing difficulty during exertion like running or climbing stairs.
Babies born with large hernia can have severe breathing problems after birth and may be needed to be kept on artificial breathing support on a ventilator.
Sometimes when the intestines which have migrated into the chest can get twisted and this can cause intestinal obstruction causing vomiting and inability to pass stools.This is a serious life-threatening emergency.

How is diaphragmatic hernia treated?

Small diaphragmatic hernias which don’t cause any symptoms do not require any treatment.Large symptomatic hernias need repair.In most cases, this repair is done laparoscopically.A mesh is usually placed to cover the defect and the hernia is repaired.The recovery time after a laparoscopic hernia repair is usually very short and patients are back to their normal activities in a week.

 

Authored By Dr G Parthasarathy - Surgical Gastroenterologist, Hyderabad