Diaphragm Repair Surgery

Although diaphragm damage caused by congenital disabilities and physical trauma is rare, it may be serious and require surgical repair. Other conditions affecting the diaphragm, such as paralysis and hiatal herniation, may not often require surgery, depending on the severity.

The diaphragm is a muscle located below the heart and lungs. It helps with breathing by contracting so the lungs expand as air comes in and relaxing so air is forced out of the lungs. Diaphragm conditions may cause pain and breathing difficulties. If you've been diagnosed with a diaphragm condition, your personalized treatment plan will be developed based on a thorough diagnosis and medical examination.

What Are the Symptoms of a Ruptured Diaphragm?

Symptoms of a possible ruptured diaphragm may vary depending on the cause, which can be any of the following:

Birth Defects

Typically, diaphragmatic hernias are present at birth (congenital), affecting one in every 3,600 babies born in the United States. This condition involves an abnormal hole in the diaphragm, causing abdominal organs (such as the liver, intestines and stomach) to move through the hole. Symptoms of congenital diaphragmatic hernia (CDH) include:

• Underdeveloped lungs
• Low oxygen levels
• Breathing difficulties
• Persistent pulmonary hypertension – happens when normal circulatory changes fail to occur shortly after birth and may result in respiratory failure.

On the other hand, acquired diaphragmatic hernia (ADH) in adults is often due to injury or trauma.

Physical Trauma

More than 90% of diaphragm injuries occur due to vehicle crashes. Most diaphragm injuries affect the body’s left side, possibly because the liver on the right side provides some protection. The force required to cause diaphragm injury is so strong that it often damages other organs like the lungs, liver, spleen, and stomach. Injured diaphragm symptoms include:

• Rapid or difficulty breathing
• Rapid heart rate
• Bowel sounds in the chest
• Reduced breath sounds

Other Conditions Affecting the Diaphragm

If your doctor determines that your diaphragm condition is not a serious concern or you have significant surgery risks, your healthcare provider will monitor your condition to ensure it does not worsen or cause problems. They may recommend abdominal trusses and binders to minimize symptoms by flattening your diaphragm area.

The following diaphragm conditions may be generally managed non-surgically. Surgery may be considered when conservative treatment does not improve symptoms.

Diaphragm Paralysis

A paralyzed diaphragm does not tighten as it normally should when breathing in. Most people may only have paralysis in one half of the diaphragm and thus may not experience any symptoms because the other half often compensates for the paralyzed part. In some people with diaphragm paralysis, symptoms may include:

• Chest pain
• Difficulty sleeping
• Fatigue
• Shortness of breath both at rest and when active

Hiatal Herniation

Hiatal herniation occurs when organs in the abdomen bulge into the chest cavity. This condition may be caused by:

• Being born with an unusually wide diaphragm opening
• Diaphragm injury
• Obesity
• Intense and persistent pressure on the surrounding muscles due to:
  • Persistent coughing
  • Heavy lifting
  • Repetitive vomiting
  • Overexerting during bowel movement

Hiatal hernia symptoms include:

• Abdominal pain
• Abdominal bleeding/blood loss
• Difficulty swallowing
• Heartburn
• Chest pain
• A bitter taste in the mouth
• Feeling nauseous
• Feeling full after a small amount of food
• Regurgitation - happens when partially digested food rises from the stomach and into the mouth

How Is a Diaphragm Condition Diagnosed?

Some diaphragm conditions may be diagnosed through imaging exams intended for another condition. In general, the following procedures may be able to locate a diaphragm injury:

• Chest radiography
• Ultrasound
• Computed tomography (CT)
• Thoracoscopy or laparoscopy

A serious diaphragmatic injury is an emergency best managed by an interdisciplinary medical team, including a trauma surgeon, radiologist, general surgeon, nurse practitioner, emergency department physician and trauma nurses. Infants with a diaphragmatic hernia need surgical repair soon after they are born.

The Diaphragm Repair Procedure

Patients with severe diaphragm conditions, especially infants, must be stabilized before undergoing diaphragm repair. They may require a breathing machine before or after surgery. Imaging and blood tests will be done before surgery, and the patient’s vitals will be monitored during surgery. The surgical approach for diaphragm surgery will vary for each patient and may include:

• Laparoscopic repair – small incisions will be made in the abdominal area where surgical tools will be inserted to repair diaphragm damage. It can be performed with or without surgical mesh, a medical device providing additional support to damaged or weakened tissue.
• Robotic repair – the surgeon controls surgical tools connected to a specialized robotic platform. Like laparoscopic repair, robotic repair only involves small incisions.
• Open surgery – the surgeon repairs the diaphragm damage through a large incision in the abdomen. It can be done with or without mesh.

After surgery, the patient may need to stay in the hospital, depending on their condition and surgery. Recovery is generally shorter for laparoscopic or robotic surgery since these methods only use small incisions compared to the larger incisions needed for open surgery. It is important to follow the doctor’s instructions to help with recovery.