Diaphragmatic hernias presented to the hospital were due to trauma. A total of 5 procedures were done successfully using an anesthesia machine rebreathing bag for ventilation.
To clear the thoracic region from herniated abdominal organs and return the normal respiration of the patient.
Complete blood count, serum chemistry, urinalysis, and radiographs were performed prior to surgery of patients. Two teams of doctors were utilized; one to perform the surgery and the other to do the anesthesia and life support. A ventral midline incision is made towards the cranial part of the abdomen from xyphoid to umbilicus.
Abdominal organs are then retracted into place. The thoracic cavity is washed with saline solution and suctioned well while the patient is on an inclined plane with the head higher than the rest of the body. Diaphragm closure is done dorsally to ventrally with a continuous suture pattern. Either an absorbable or non-absorbable monofilament suture can be used to close the diaphragm.
The important part is 4 breaths/minute or 1 puff/15 seconds using the right bag for the patient size. Before total closure of the tear, a Fr. 7 tube is inserted and negative pressure is applied. Timing is essential. Tighten the last knot while removing the tube to allow negative pressure to remain inside the thorax. Stop the assisted breathing and monitor the patient’s normal respiration. The abdomen is then closed routinely.
All five cases were operated on successfully, with only one experiencing respiratory complications.
Diaphragmatic hernias may be successfully repaired without the use of a ventilator.