Minimal Invasive Surgery in 2.5kg Newborn

28-year-old Danielle was in her 8th month of pregnancy when an ultrasound scan revealed that the fetus in her womb suffered from a complex hiatal hernia defect that was formed in the early stages of her pregnancy, a situation that could threaten the fetus's life. Prof. Gilboa Yanun, Director of the ObGyn Ultrasound Unit at Beilinson Hospital, diagnosed the rare disorder in the infant in utero. The condition resulted from a malformation during the development of the diaphragm that caused the entire stomach to be located in the chest cavity instead of the abdominal cavity, and pressed on the heart and lungs of the infant. Following a discussion with surgeons at Schneider Children's, the doctors in the Gynecology Department at Beilinson decided to closely monitor the continued pregnancy together with surgeons at Schneider.

The infant, who was born weighing 2.5kg, was immediately transferred to the Neonatal Department at Schneider Children's headed by Prof. Gil Klinger, where he underwent imaging tests to confirm the complex defect called a mixed congenital hiatal hernia. In the majority of cases, surgery to repair this defect requires an incision that leaves a large scar on the infant's abdomen. However, Dr. Dragan Kravarusic, Director of the Surgery Department at Schneider Children's, decided to perform minimal invasive surgery obviating the need for a large incision and promoting speedier recovery and a shorter hospitalization stay. Prior to the operation, it was important to exclude the existence of a "short esophagus". Accordingly, Dr. Ari Silbermintz, senior gastroenterologist in the Institute of Gastroenterology, Nutrition and Liver Diseases, performed an endoscopy to rule out that possibility.

In the second week of his life, the infant underwent surgery to repair the hiatal hernia which was performed by Dr. Kravarusic and Dr. Emanuel Segaya, closely attended by a team of anesthetists headed by Dr. Yaacov Katz. The procedure included separation of the cojoined tissues between the stomach, cardiac membrane and lungs, and proceeded without any complications. Following the surgery, the infant was soon breathing on his own and began to feed the day after.

The Department of Pediatric Surgery at Schneider Children's provides a range of surgical solutions to diverse and complex disorders. The department supports and develops minimal invasive surgery for abodominal and chest cavity procedures in children and neonates. This surgical approach is the preferred technique from the funcional and aesthetic standpoint, demanding the most advanced equipment and the highest skills from the team of surgeons and anesthetists.

Dr. Kravarusic stated that "we are pleased to have had the opportunity to help the infant and his family undergo the complex and advanced minimally invasive procedure at Schneider Children's, which avoided the need for open abdominal surgery and promoted a rapid recovery, shorter hospitalization and an early discharge. The recipe for success is based and depends upon teamwork and close collaboration among the different disciplines."