Operative Closure (Congenital Diaphragmatic Hernia)

atno_29a_n.jpg to atno_29d_n.jpg: 3.8-year-old girl with a relatively small left diaphragmatic hernia (open pleuroperitoneal channel). Steps of surgery. Pleuroperitoneal diaphragmatic hernias do not need emergency surgery any more; rather, the operation is performed with a delay following stabilization of the newborn. The access is either transabdominal or by thoracotomy. atno_29a_n.jpg: Operative findings on the view from below toward the diaphragm. The loops of the intestine are reduced from the thoracic into the abdominal cavity by gentle traction. atno_29b_n.jpg and atno_29c_n.jpg: The defect in the middle of the diaphragmatic dome is recognizable without and with retractor. atno_29d_n.jpg: The defect is closed from lateral to medial in two layers. To the left of the patient (right side of the picture) one suture is already done; a closure without tension is possible. The relatively large spleen is held in a medial direction.