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Infant born with herniated diaphragm saved at Hadassah Hospital

First-of-its-kind operation in Jerusalem saves newborn's life

Infant born with herniated diaphragm saved at Hadassah Hospital, thanks to advanced, micro-invasive procedure.

The delivery room team realized there was a problem with the baby, due to respiratory distress.

An ultra sound showed a diaphragmatic hernia.

When the diaphragm, the thin sheet of muscle that separates the abdomen from the chest, doesn’t form properly, organs that are normally in the abdomen can be pushed (herniated) through the opening into the chest. The baby’s small intestine, colon and spleen were in the chest, pressing on the lungs and heart.

The baby was put on a respiratory device to stabilize her condition while the doctors prepared for the procedure.

Her parents, Libby and Joe Preiger, say that despite many prenatal tests and follow ups at their local health provider, they didn’t know that their daughter suffered from the hernia. They expressed complete trust and faith in the Hadassah doctors "to treat our baby in the best way possible.

Dr. Amos Fruman, director of the Pediatric Surgery Department at Hadassah Hospital, says that in most cases, babies born with this syndrome need to undergo a major operation involving opening of the thorax, pushing back the organs to the abdomen and a closure of the diaphragm.

But this time, an idea came up and in a team brainstorming session. They decided to perform thoracoscopy: a minimally invasive surgery using two optic fibers and a camera, a procedure that does not require the opening of the chest.

"Our team knows how to do this, but we had to make sure there was no cardiac or pulmonary problem common in those with a diaphragmatic hernia," Dr. Fruman said. “Despite the great challenge of thoracoscopic surgery we wanted to make it easier for the baby. Our team was called in from home, and we carefully prepared for the first procedure of its kind here. It was quite an operation.”

Dr. Diaa Zagiir, a senior physician in pediatric surgery, operated on the baby, Dr. Vadim Kapuller was responsible for the imaging during the operation, with the insertion of the optical fiber. Dr. Miriam Rauschenbach played a key role as anesthesiologist.

"Thoracoscopic is an operation in which a micro camera and two fibers are inserted through the thorax to close the rupture, inserted through three holes, three millimeters wide each," explains Dr. Zegiir. It is difficult because there is very little space there anyway, but it’s even tighter with babies. That’s why most surgeons prefer open chest surgery. But we have the best technology, and we know how to use it. We realized that this was the best option for this baby”.

If surgery involving thoracic opening is performed, it doubles the operation time, as well as the recovery period. The baby would have had to stay in the emergency care unit for weeks rather than a few days. This also prevents the higher risk of postoperative infection and even the twisted backs of scoliosis.

The operation was successful, and the baby began to show positive signs of recovery. “She is a real trooper and we are happy that we enabled the sweet baby to lead a full, normal, healthy life," says Dr. Fruman. "This is the essence of the work we do at Hadassah Pediatric Surgery."

"Our baby Bina is healthy now, and against all odds this life-saving procedure took place quickly, with minimal suffering for our baby” says her mother Libby. "Bina will grow up to be a healthy baby, thanks to the amazing staff at Hadassah who did not hesitate and chose the right surgical procedure for her. We will never forget it and will tell her all about it when she grows up.”

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