CPT® Code 39503

1. Indications

The procedure for repairing a neonatal diaphragmatic hernia is indicated in the following situations:

• Bochdalek Hernia This type of hernia occurs on the left side of the diaphragm and is characterized by the herniation of the stomach and intestines into the thoracic cavity.
• Morgagni Hernia This hernia occurs on the right side of the diaphragm, leading to the herniation of the liver and intestines into the thoracic cavity.
• Respiratory Distress Infants presenting with significant respiratory distress due to the presence of a diaphragmatic hernia may require surgical intervention to alleviate symptoms and restore normal respiratory function.
• Failure to Thrive Neonates who exhibit failure to thrive or poor weight gain as a result of the hernia may also be candidates for this surgical repair.

2. Procedure

The surgical procedure for repairing a neonatal diaphragmatic hernia involves several critical steps:

• Step 1: Incision A subcostal incision is typically made below the ribs to provide access to the abdominal cavity. This incision allows the surgeon to examine the abdominal viscera and assess the extent of the hernia.
• Step 2: Examination of Abdominal Viscera Once the incision is made, the surgeon carefully inspects the abdominal contents to identify any herniated organs and determine the appropriate course of action for repair.
• Step 3: Reduction of Herniated Contents The herniated abdominal contents, such as the stomach and intestines in the case of a Bochdalek hernia or the liver and intestines in a Morgagni hernia, are gently reduced back into the abdominal cavity.
• Step 4: Excision of Hernia Sac After the contents are reduced, the hernia sac is excised to prevent future complications and to facilitate the repair of the diaphragm.
• Step 5: Repair of Diaphragm The defect in the diaphragm is then repaired. For small defects, a single-layer suture repair may be sufficient. In cases of larger defects, a synthetic patch graft is utilized to reinforce the repair.
• Step 6: Abdominal Wall Repair If the abdominal cavity is too small to accommodate the abdominal contents after reduction, the abdominal wall may be repaired with a prosthetic patch placed over the contents, resulting in a ventral hernia that will require repair in a subsequent procedure.
• Step 7: Chest Tube Insertion At the conclusion of the procedure, one or more chest tubes may be inserted to facilitate drainage and prevent fluid accumulation in the thoracic cavity.

3. Post-Procedure

Post-procedure care for infants who have undergone repair of a neonatal diaphragmatic hernia includes monitoring for respiratory function and ensuring that the chest tubes are functioning properly to prevent complications such as pneumothorax or pleural effusion. The infant will typically be observed in a neonatal intensive care unit (NICU) for any signs of distress or complications. Pain management and nutritional support may also be necessary during the recovery period. Follow-up evaluations will be required to assess the integrity of the diaphragm repair and to plan for any additional surgical interventions needed for ventral hernia repair if applicable.