Diaphragm Repair
The diaphragm is the muscle that stretches along the bottom of the rib cage. It plays a crucial role in respiration, and separates the heart and lungs from the stomach, liver, spleen and intestines (abdominal organs). If the diaphragm is herniated (has a hole in it), the abdominal organs can push upward through the hole and into the chest, interfering with breathing. A herniated diaphragm must be repaired immediately.
There are several reasons that a diaphragm may need repair. They include congenital defects, age-related hiatal herniation, and physical injury. A diaphragm injury is often difficult to diagnose because its symptoms are similar to those of other conditions. Diagnostic tests, including X-ray, CT scan or ultrasound, are often used to determine the cause of symptoms. In certain circumstances, an exploratory laparotomy, in which a large incision is made in the abdomen, is performed to accurately diagnose a hernia. If a hernia is found, it can then immediately be repaired.
The Diaphragm Repair Procedure
Although diaphragm repair can be performed as open surgery, which involves a six- to 10-inch incision, it is most often performed laparoscopically. The latter requires only small incisions and results in less pain, less scarring, and a shorter recovery time. Usually, five incisions are made in the abdomen, and a laparoscope (a tiny telescope with a video camera at its end) is inserted through one of the incisions so that the surgeon can see the interior of the abdominal cavity. The other incisions are made to accommodate the instruments used to assist in the repair. The surgeon gently maneuvers any protruding organs back through the hole in the diaphragm and into the abdominal cavity. The opening in the diaphragm is closed with stitches, staples and/or mesh.
Risks of a Diaphragm Repair
Risks related to diaphragm repair include those related to any surgery, and include excessive bleeding, infection and damage to adjacent organs. Risks related specifically to diaphragm repair include collapsed lung (pneumothorax), and respiratory failure.
Recovery from Diaphragm Repair
After a repair of the diaphragm, the patient usually returns home in a day or two. Pain medication is prescribed, and the patient is instructed to limit physical activity and heavy lifting for about a month. If the following symptoms occur post-surgery, they should be reported to the physician immediately:
- Severe pain at the surgical site
- High fever
- Difficulty breathing or swallowing
- Swelling, redness or odor at the incision site
The absence of a bowel movement for 3 days should also be reported to the physician.