Abstract

AbstractCongenital hernias of the diaphragm present in two distinct forms: acute pulmonary insufficiency in the newborn, and chronic recurrent respiratory disease in older children. The high mortality rate in the neonate is due to hypoplasia of the lungs, resulting in respiratory acidosis and hypoxia. In older children herniation of viscera probably occurs after complete expansion of the lungs. Preoperative management includes correction of metabolic acidosis, maintaining normal body temperature, and, if necessary, assisting ventilation via an endotracheal tube. A subcostal abdominal incision has been used for left diaphragmatic defects; only right diaphragmatic hernias are approached by thoracotomy. In the eight-year period, 1964 to 1972, nine infants and children have been treated with only one death,—an 89% survival rate.