Pediatric surgery. Treatment of complicated true hernias of the diaphragm itself (the most important)

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Pediatric surgery. Treatment of complicated true hernias of the diaphragm itself (the most important)

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27. Treatment of complicated true hernias of the diaphragm proper

In case of an acute course or infringement of a true hernia of the diaphragm itself, an urgent operation is indicated. Preoperative preparation is minimal.

The young child is warmed after transport, the necessary drugs for anesthesia are administered, and an intravenous fluid infusion machine is applied.

The operation is performed under endotracheal anesthesia. The position of the child with transthoracic access is on the side opposite to the hernia, with laparotomy - on the back.

With the parietal location of the hernial sac, so-called sliding hernias are usually observed. In such cases, it is more convenient to dissect the thinned zone in an arcuate manner over the displaced organs and move the latter in a blunt way (together with part of the hernial sac) downwards.

Postoperative treatment. In the postoperative period, newborns are placed in a heating incubator and an elevated position is created (after the child has recovered from the state of anesthesia), and humidified oxygen is prescribed.

On the first day, every 2 hours, the accumulating contents are sucked out of the stomach with a thin probe. Parenteral nutrition is carried out for 24-48 hours. After 2-3 days, for the purpose of stimulation, blood transfusions are performed in the amount of 20-25 ml. Feeding by mouth usually begins on the 2nd day after surgery: every 2 hours, 10 ml of glucose solution, alternating with breast milk. The fluid deficiency is replenished by intravenous administration of a glucose solution, and after the removal of the drip infusion apparatus, by single-stage transfusions.

If there is no vomiting, then from the 3rd day the amount of fluid is increased, gradually bringing it to the age norm. On the 7-8th day, the child is applied to the chest.

Older children are also transferred to parenteral nutrition on the first day, then a liquid postoperative table with a sufficient amount of proteins and vitamins is prescribed. The usual diet starts from the 6-7th day.

All children after surgery are prescribed broad-spectrum antibiotics to prevent pneumonia and heart medications. Physiotherapy (UHF currents, then KI iontophoresis) is prescribed from the day following the operation. Therapeutic breathing exercises begin from the first days, gradually moving to more active exercises.

After the operation, the first x-ray examination is carried out on the operating table, while determining the level of standing of the diaphragm and the degree of expansion of the lung. Re-examination in a satisfactory condition is done in 3-5 days.

If prior to this, an effusion in the pleural cavity is clinically detected and the child's condition remains severe, an X-ray examination is performed on the 2nd day after the operation. In some cases, this helps to identify indications for puncture (presence of profuse effusion).

Authors: Drozdov A.A., Drozdova M.V.

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