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Physician Update - Better outcomes for congenital diaphragmatic hernia

Physician Update Winter 2012

Better outcomes for congenital diaphragmatic hernia

Date: December 1, 2011

For their tiny patients, Jeffrey Lukish and his colleagues have adapted advances in minimally invasive techniques that previously were reserved for adults.

Once in about every 3,000 live births, babies are born with their intestines displaced into the chest cavity. Until recently, the condition often meant that the newborn would not survive.

"But things are changing," says Jeffrey Lukish, a pediatric surgeon dedicated to improving outcomes for infants with congenital diaphragmatic hernia.

For one thing, Lukish explains, physicians have greatly improved the ability to image the intestinal protrusion months before the child is born. That warns expectant mothers that birth should take place in a hospital with wide-ranging neonatal and pediatric intensive care.

Because the protruding bowel compresses lungs and heart, these babies typically present with respiratory distress severe enough to warrant rapid transfer to a neonatal intensive care unit. 

Virtually all of these infants need surgery to reverse the herniation, and it's surgery, Lukish says, that's provided the main advances.

Today, Lukish and his colleagues are able to restore the protruding bowel back below the diaphragm using just three keyhole incisions, each about 3 cm. across. The minimally invasive method eliminates the larger, standard incision into the chest cavity, speeding recovery.

But that’s not the only advance, says Lukish. A new suturing technology developed for adult operations extends nicely to pediatric cases. Lukish and colleagues use suture lined with fine barbs, eliminating the need to tie off each stitch. That, of course, speeds closing, giving the newborn patients yet another edge for survival.

Lukish says he and his group performed six of the hernia repairs last year, all successfully. 

To refer a patient 410-955-5628

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