ABDOMINAL-WALL PLASTY FOR A PREMATURE-INFANT WITH CONGENITAL DIAPHRAGMATIC-HERNIA

This paper reports a premature infant with a congenital diaphragmatic hernia (CDH) who underwent an abdominal wall plasty to enlarge the abd ominal cavity, one of twin infants born at 32 weeks weighing 1,255 g. After stabilization, the herniated viscera were reduced from the pleur al cavity and the abdominal wall muscle and skin layers were replaced by a Gore-tex patch without closure of the diaphragmatic defect. Respi ratory and circulatory conditions were stable during the perioperative period. Postoperatively, a roentogenogram showed expansion of the lun g. However, his condition deteriorated 34 h after surgery, triggered b y intratracheal suction, and he died on the 4th day of life despite th e use of high-frequency oscillation, catecholamines, and vasodilators. Postmortem examination showed severely hypoplastic lungs. Abdominal w all plasty may be a less invasive initial procedure, however, further studies, such as comparison with the standard method or conservative m anagement, are needed using a large clinical group or animal models to justify the usefulness of this procedure.