What Does Hernia Mean?

There are different cavities in our body (such as the chest and abdominal cavities). The organs in these cavities cannot pass from one to another due to some anatomical structures. For example, the abdominal organs cannot pass into the chest cavity. The displacement of organs to different cavities or to the outside of the body due to a defect in the anatomical structures that prevent this passage is generally called a hernia or hernia.

What is Diaphragmatic Hernia?

First, let's explain the diaphragm. The diaphragm is an anatomical structure consisting of muscles and fibers that separate the abdominal cavity from the chest cavity. Thus, the organs in both cavities cannot pass from one to the other.

If there is an opening in the diaphragm for any reason, the abdominal organs are displaced towards the chest cavity, which is called a diaphragmatic hernia.

Why Does Diaphragmatic Hernia Occur in Children?

Diaphragmatic hernia can be evaluated under two headings as congenital or acquired (occurring later). Those that occur later usually occur after a trauma. However, almost all diaphragmatic hernias in children are congenital. Therefore, congenital diaphragmatic hernia will be discussed here.

The diaphragm consists of several separate parts while developing in the womb, these parts unite to form a whole. Diaphragmatic hernia occurs in cases where this unity is incomplete.

The exact cause of congenital diaphragmatic hernia is not known. However, since chromosomal errors are detected in 25-30% of patients, it is thought that some genetic factors may play a role.

Are There Different Types of Diaphragmatic Hernia in Children?

Yes, there are. First of all, as mentioned above, it is divided into two as congenital and acquired. Congenital ones are divided into two as Bochdalek (Posterolateral-back side-) and Morgagni (Anterior-front-).

How is Diaphragmatic Hernia Diagnosed in Children, What Are the Symptoms?

The main thing in diagnosis is the history and physical examination. The baby's follow-up status in the womb should definitely be questioned in the history. Since there are serious developments in the womb follow-up today, most patients are diagnosed with ultrasound performed in the womb.

If the diagnosis is not made in the womb, respiratory distress begins when the baby is born, especially the lips, and generally cyanosis, which we call bruising, sometimes difficulty swallowing, and the abdomen may be sunken.

In the physical examination, the heart is pushed and lung sounds cannot be heard on the side where the hernia is. Intestinal sounds can be heard on this side with good listening. The heart rate and respiratory rate are accelerated. The diagnosis is confirmed with lung radiography and sometimes tomography and/or medicated radiography.

Which Diseases Should Be Considered in the Differential Diagnosis of Congenital Diaphragmatic Hernia?

• Cystic adenomatoid malformation
• Cystic teratoma
• Pulmonary sequestration
• Bronchogenic cyst
• Neurogenic tumors

 

Can There Be Additional Anomalies Accompanying Diaphragmatic Hernia in Children?

Yes, It Can. Especially; anomalies such as heart, intestine, esophageal atresia, abdominal wall defects (omphalocele) are frequently encountered anomalies.

Are There Factors Affecting the Survival Rate of the Baby in Diaphragmatic Hernia in Children?

Yes, there are. Scientific studies have shown that the criteria we will list reduce the baby's survival rate and increase the complication rate.

These are;

• Low lung area / head circumference ratio
• Polyhydramnios
• Diagnosis before the 25th week
• Left ventricular hypoplasia
• Baby being born early (prematurity)
• Baby being born with a birth weight of less than 1000 grams
• Early onset of respiratory distress after birth (especially in the first 24 hours)
• Existence of additional anomalies (especially heart)
• Needing to be connected to a ventilator
• Development status of the lungs
• Stomach and liver being in the chest cavity
• Side of the hernia
• Parameters in blood tests called blood gas being below certain values.

What is the Treatment of Diaphragmatic Hernia in Children?

The definitive treatment for Diaphragmatic Hernia in children is surgery. However, first of all, the baby's heart, lung and other problems need to be regulated. Therefore, we evaluate this condition as a physiological emergency.

The main thing here is that the baby must be delivered in a hospital where there is intensive care and the knowledge, experience and technical facilities to perform the surgery. A baby with diaphragmatic hernia, whose birth plan is made appropriately, should be given the necessary respiratory and medical support as soon as it is born and a surgery plan should be made at the most appropriate time. The chances of success of the operations performed after the respiratory and oxygenation status are regulated, usually within 24-48 hours, are higher. With this surgery, the organs are placed in their proper places and the hole in the diaphragm is closed.

Can Lung Surgical Diseases Be Performed Thoroscopically or Laparoscopically (Closed)?

Yes, it can be done. With the development of technology, closed surgeries can be performed even on 1-month-old babies.

How Are Lung Surgical Diseases Performed Thoroscopically or Laparoscopically?

In closed surgery methods, a large incision is not made between the ribs as in open surgery. It does not have to be opened by placing a retractor. 5-10 mm diameter instruments are placed through 2 or 3 holes in the thoracic wall (chest wall) and surgeries are performed through these holes. Closed surgeries provide a wider viewing angle compared to open surgeries.

In laparoscopy, this procedure is performed from the abdomen in the same way as in thoracoscopy.

Does Closed Surgery (Thoracoscopic-Laparoscopy) Have Advantages?

Yes, there are, the main advantages are; less pain, shorter recovery period and more aesthetics. Thoracoscopic-Laparoscopic method provides a wider viewing angle compared to open surgeries. The patient may need to stay in intensive care for one day and is discharged in 2-3 days.

It should not be forgotten that thoracoscopic-laparoscopic (closed) surgeries require serious experience, knowledge and skill along with advanced technology. Otherwise, it should not be forgotten that serious complications may occur.

What Kind of Problems Can Be Encountered After Treatment of Diaphragmatic Hernia in Children?

After the surgery, sometimes very serious respiratory support must be provided for quite a long time. Afterwards, the development rate and capacity of the baby's lungs are monitored. In these babies with inadequate lung development, respiratory distress symptoms, infection findings, some heart problems and gastroesophageal reflux may occasionally occur. Along with monitoring the lung capacity, these problems are also tried to be monitored and treated.

Diaphragmatic Hernia is a disease that requires serious surgery and has high mortality and morbidity, i.e. death and post-treatment complications.

*** The information provided here, the content of the website, is arranged for the purpose of informing visitors, especially families. No information should be considered as advice by visitors and should lead to any decision or action. Families should definitely have their patients examined by a pediatric surgeon, consult with him and make a decision by consulting his/her personal information.