Diaphragmatic hernia

What is a diaphragmatic hernia?

A diaphragmatic hernia refers to an enlarged opening or a defect in the diaphragm which allows your abdominal organs to pass through into your chest. This is a type of internal hernia and is not caused by a defect in the peritoneum. An external hernia, in contrast, has a defect in the abdominal wall, which often results in a visible protrusion of the affected abdominal region. The most common type of diaphragmatic hernias is the hiatal hernia. Here, a part of the stomach is pushed through the esophageal opening in the diaphragm into the thorax.

How is a diaphragmatic hernia detected?

A congenital diaphragmatic hernia is usually detected directly after birth. If abdominal organs such as parts of the stomach or intestines have already entered the chest through the defect, they can be heard with help of a stethoscope as part of the routine examination. Bowel sounds like gurgling and bubbling are usually only noticeable when auscultating the abdomen, so these are typical for a diaphragmatic hernia. In addition, the lungs can be restricted by the pressing abdominal organs, which can lead to weakened breathing sounds. Alternatively, imaging techniques like esophageal endoscopy or a chest X-ray can help diagnose the condition. Before birth, the hernia is usually detected during ultrasound examinations.

Are there treatment options available before birth?

Treatment methods before birth are still being researched and are currently not very common. If a diagnosis has already been made before birth, it is advisable to deliver the child through a planned caesarean section in a hospital equipped with a neonatal intensive care unit. Here, depending on the severity of the condition, the child can be directly intubated after birth and stabilized with the necessary additional measures.

What are the biggest problems and risks of a congenital diaphragmatic hernia?

Most complications of a congenital diaphragmatic hernia are due to the compression of the chest organs by the abdominal organs. Compression of the lungs carries the risk of respiratory insufficiency; in other words, failure to breathe, leading to oxygen deficiency. Additionally, there may can be heart function problems if the heart can no longer beat in the restricted space. The affected abdominal organs can also suffer by being compressed in the diaphragm.

How and when is a diaphragmatic hernia operated on?

When exactly the surgery is done depends on the general condition of the affected child. The target time for surgery is around two days after birth, and the operation is therefore usually performed directly in the pediatric intensive care unit to avoid additional cardiovascular stress. Depending on the size of the defect, there are different methods of operating on the hernia. One option for suturing the diaphragm is minimally invasive, laparoscopic surgery. In this procedure, a camera and two instruments are inserted into the chest, leaving only small externally visible scars after the operation. For larger defects, the abdominal cavity must be opened, and the diaphragmatic hole is closed using a patch.

Prognosis and possible long-term effects

The prognosis depends on the severity of the defect and the treatment methods used. The survival rate varies between 70 and 90% depending on the clinic. One important long-term effect is the recurrence of the hernia after the surgical repair. Moreover, the surgery can lead to a constriction of the stomach in the section connected to the esophagus through the diaphragm. This may result in digestive problems such as nausea, and abdominal pain and often results in vomiting after large meals.

Which doctors and clinics specialize in the diagnosis and treatment of diaphragmatic hernias?

If a diaphragmatic hernia is diagnosed before birth, it will generally be diagnosed by the gynecologist during ultrasound examinations. After the birth of the child, the treatment is carried out by a team of pediatricians and pediatric surgeons. As previously mentioned, the delivery should ideally take place in a clinic with a directly connected newborn intensive care unit and a pediatric surgery unit to guarantee direct care and stabilization of the child.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of diaphragmatic hernias. They are looking forward to and are ready to address your questions and treatment requests.