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Less Invasive Congenital Diaphragmatic Hernia Repair

January 26, 2012
Lukish 2 dtl

Jeffrey Lukish, M.D.

Once in about every 3,000 live births, babies are born with all of their intestines up in their chests, and until recently, the condition often meant that the newborn would not survive. But things are changing, says pediatric surgeon Jeffrey Lukish, who is among a group of experts at Hopkins Children’s improving outcomes for infants with congenital diaphragmatic hernia.

For one thing, Lukish explains, physicians have greatly improved the ability to detect the hallmark protrusions with prenatal imaging months before the child is born. These early warnings themselves improve outcomes, he says, because the affected expectant mothers then know they need to deliver in a hospital that can provide the wide-ranging neonatal and pediatric intensive care that such newborns need.

With their protruding bowel compressing their lungs and heart, babies typically present with respiratory distress that requires rapid transfer to the care of NICU specialists. Virtually all of these infants will need surgery to reverse the herniation, and this, Lukish says, is where the prognosis is changing most.

Although it’s always best to postpone the procedure as long as possible to give the infant time to gain strength to handle it, Lukish says that in today’s diaphragmatic hernia cases, he and his surgical colleagues are able to restore the protruding bowel back below the diaphragm using just three 3-centimeter keyhole incisions. Their minimally invasive method eliminates the need to make the more  traumatizing open incision into the chest cavity required in the standard procedure and helps speed recovery after the operation.

But that’s not the only advance, says Lukish. His group has also adapted a new suturing technology developed for adult operations that seems to extend nicely to pediatric cases. They are using sutures lined with fined barbs that negate the need to tie off the line with each stitch, which speeds closing and gives the newborn patients yet another edge for survival.

Lukish says he and his group have already performed these hernia repairs six times during the past year, all successfully. For more information, call 410-955-5628.