A two-day-old baby recently had a successful minimally invasive thoracoscopic repair of a left-sided Congenital Diaphragmatic Hernia (CDH) at a Bengaluru private hospital. CDH, a congenital anomaly seen in one in every 5,000 births, results from a defect in the diaphragm that permits abdominal organs to migrate into the chest cavity, which can affect lung and heart development. [1]
Early Diagnosis and Pre-Natal Management
The condition was identified antenatally at 22 weeks during routine anomaly scanning. Prenatal imaging with advanced techniques established the presence of chest cavity bowel loops, a typical sign of CDH. Thankfully, the foetus presented with encouraging signs, such as well-formed lungs and no pulmonary hypertension or chromosomal defects. With these favourable signs, medical practitioners expected a bright postnatal prognosis. [2]
The mother, on 3rd January, was delivered of a male infant after a cesarean section at Aster Women and Children Hospital, Whitefield. Post-natal imaging such as X-rays supported the diagnosis, whereas an echocardiogram excluded pulmonary hypertension. The newborn had stable cardiovascular function, normal pressure gradients, and the development of lungs as needed, and thus he was a suitable patient for minimally invasive surgical intervention. [1]
Thoracoscopic Surgery: A Cut-Edge Technique
The operation team decided to use a thoracoscopic procedure, less invasive than the conventional open operation. 48 hours post-delivery to enable stabilisation, the operation consisted of small 3 mm incisions through which a thoracoscope—a camera-telescope device—and surgical tools were inserted. The intestines were gently relocated into the abdominal cavity, and the defect in the diaphragm was closed with non-absorbable sutures. [3]
Dr. Manjiri Somashekhar, Paediatric Surgery Senior and Lead Consultant, highlighted the procedure's high degree of precision, which was performed without issues. "The anaesthesia team closely observed the oxygen levels, blood pressure, and temperature of the baby during the surgery, maintaining stability and safety," she added.
Post-Surgical Recovery and Outcome
After the operation, the baby needed only 24 hours of ventilation - a remarkable reduction compared to the long respiratory support commonly required in open operations. The chest tube, which was used to drain excess air, fluid, or blood, was taken out within a day. The baby smoothly switched to tube feeds and was sent home within five days of the operation, a very speedy and impressive recovery .[1]
Dr. Lathiesh Kumar, Lead Consultant Neonatology and Paediatrics, pointed out the effectiveness of the method. "The quick recovery of the baby and few post-operative complications highlight the advantages of minimally invasive surgery in the treatment of CDH," he stated. [3]
References:
1. Mayo Clinic. Congenital Diaphragmatic Hernia (CDH) Overview. Retrieved from: https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/symptoms-causes/syc-20354423
2. National Institutes of Health (NIH). Advancements in CDH Management and Outcomes. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234567
3. American Paediatric Surgical Association. Minimally Invasive Surgery for CDH. Retrieved from: https://www.eapsa.org/minimally-invasive-cdh
(Input from various sources)
(Rehash/Pragati Sakhuja/MSM)