Congenital Diaphragmatic Hernia (CDH) Repair
What is Congenital Diaphragmatic Hernia (CDH) Repair?
Congenital Diaphragmatic Hernia (CDH) repair is a surgical procedure to correct a defect in the diaphragm, a muscle separating the chest and abdomen, where a hole allows abdominal organs (e.g., intestines, stomach) to enter the chest cavity, impairing lung development. It’s typically performed in newborns, often as an emergency. In India, CDH repair is conducted in pediatric surgery departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, often at affordable costs. Understanding the procedure, costs, recovery, risks, and FAQs is essential for caregivers.
Why do you need Congenital Diaphragmatic Hernia (CDH) Repair?
CDH repair is indicated for:
- Congenital Diaphragmatic Hernia (CDH):
- A defect in the diaphragm (usually left-sided, 80–85% of cases) present at birth, occurring in 1 in 2,500–4,000 live births.
- Symptoms: Respiratory distress (rapid breathing, cyanosis), scaphoid abdomen (sunken belly), or heart sounds shifted to the right.
- Associated complications:
- Pulmonary hypoplasia: Underdeveloped lungs due to compression by herniated organs.
- Pulmonary hypertension: High blood pressure in lung vessels, complicating oxygenation.
- Timing:
- Surgery typically delayed until the infant is stabilized (24–72 hours post-birth), depending on respiratory status and pulmonary hypertension.
The procedure aims to close the diaphragmatic defect, reposition abdominal organs, and support lung function, improving breathing and survival, often requiring intensive neonatal care.
Why Do CDH Repair Costs Vary in India?
Costs range from ₹1 lakh to ₹3 lakh :
- Procedure Complexity: Open surgery (₹1–1.5 lakh); minimally invasive or with ECMO (₹2–3 lakh).
- Hospital/Location: Higher in metro cities (Apollo, Fortis: ₹2–3 lakh); lower in government hospitals (AIIMS: ₹50,000–₹1 lakh, often subsidized under Ayushman Bharat).
- NICU Stay: ₹5,000–₹20,000/day, depending on ventilation/ECMO needs.
- Surgeon’s Expertise: Experienced pediatric surgeons charge more.
- Additional Costs: Anesthesia (₹10,000–₹20,000), NICU (₹50,000–₹1.5 lakh), medications (₹10,000–₹30,000).
- Insurance: Covered for congenital defects; confirm with your provider.
CDH Repair Procedure
- Before Surgery Evaluation:
- Diagnosis:
- Prenatal ultrasound: Often detects CDH (as early as 20 weeks gestation).
- Postnatal X-ray: Confirms herniated organs in chest (e.g., bowel loops in thorax).
- Echocardiogram: Assesses heart defects (30–40% of cases) and pulmonary hypertension.
- Blood tests: Arterial blood gas (ABG) to monitor oxygenation.
- Stabilization: Ventilation (often high-frequency oscillatory ventilation), nitric oxide for pulmonary hypertension, or ECMO (extracorporeal membrane oxygenation) in severe cases.
- Consent: Risks, including recurrence, are explained.
- Diagnosis:
- Surgical Techniques:
- CDH Repair:
- Performed under general anesthesia, lasting 1–3 hours.
- Approach:
- Open surgery: Subcostal incision (below ribs, 5–8 cm), more common in India.
- Laparoscopic/thoracoscopic: Minimally invasive (small incisions, camera-guided); used in stable infants at advanced centers.
- Repair:
- Herniated organs (e.g., intestines, stomach) gently reduced into the abdomen.
- Diaphragmatic defect closed with sutures (primary repair) if small.
- Patch repair: Synthetic (e.g., Gore-Tex) or biological patch used for large defects (30–50% of cases).
- Chest tube: May be placed to drain fluid/air and support lung expansion.
- Intraoperative Tools:
- Endoscope (if minimally invasive): Visualizes defect.
- Sutures/patch: Closes the defect.
- Ventilator: Supports breathing during surgery.
- CDH Repair:
- After Surgery:
- Hospital stay: 2–6 weeks (NICU).
- Care: Mechanical ventilation (days to weeks), feeding via nasogastric tube (NGT) initially.
- Pain management: Moderate pain for 3–7 days; managed with IV analgesics (e.g., fentanyl).
- Instructions: Monitor for respiratory distress; gradual weaning from ventilator.
Recovery After CDH Repair
- Hospital Stay: 2–6 weeks (NICU).
- Post-Surgery Care:
- Ventilation: Most require ventilator support for 1–4 weeks; ECMO (if used) for 1–2 weeks.
- Feeding: NGT for 1–3 weeks; oral feeding starts once stable (2–4 weeks).
- Pain/Swelling: Moderate pain for 3–7 days; incision swelling resolves in 1–2 weeks.
- Breathing: Gradual improvement as lungs adapt; pulmonary hypertension may persist.
- Activity: Normal infant activities once off ventilator; avoid pressure on abdomen.
- Follow-Up:
- Visits at 1 month, 3 months, and 6 months.
- Chest X-ray/Echocardiogram: At 1–3 months to monitor lung growth and heart function.
- Developmental assessment: At 6–12 months for milestones (e.g., feeding, growth).
Full recovery varies; many leave NICU in 4–6 weeks, but lung development continues over years. Survival rate: 60–80% with modern care (lower in severe cases with pulmonary hypoplasia); long-term outcomes depend on lung function.
Risks and Complications
- Surgical Risks:
- Bleeding (2–5%): Intra-abdominal bleeding; may need transfusion.
- Infection (3–5%): At incision site or lungs (pneumonia); treated with antibiotics.
- Anesthesia risks (<1%): Reaction to general anesthesia; rare in stable infants.
- Post-Surgery:
- Hernia recurrence (5–15%): Defect reopens, esp. with patch repair; needs revision surgery.
- Pulmonary hypertension (20–40%): May persist, requiring ongoing treatment (e.g., sildenafil).
- Bowel obstruction (2–5%): Due to adhesions; may need surgery.
- Chylothorax (1–3%): Fluid leak into chest; managed with drainage or diet changes.
- Long-Term:
- Chronic lung disease (10–20%): Due to pulmonary hypoplasia; may need oxygen support.
- Gastroesophageal reflux (GERD, 30–50%): Common in CDH; managed with medication.
- Developmental delays (10–20%): Due to prolonged hospitalization; needs therapy.
Report respiratory distress, fever, vomiting, or poor feeding promptly.
Frequently Asked Questions (FAQs)
What causes CDH?
Unknown; genetic factors, environmental exposures; occurs in 1 in 2,500–4,000 births.
Can I avoid CDH repair?
No, surgery is necessary to prevent lung damage and ensure survival; non-surgical care only stabilizes pre-surgery.
Is CDH repair painful?
Moderate pain for 3–7 days, managed with IV analgesics; infants recover with proper care.
How soon can my child resume normal activities?
Off ventilator: 1–4 weeks; normal feeding: 2–4 weeks; full recovery: Months to years (lung growth).
Is CDH repair covered by insurance in India?
Yes, for congenital defects; confirm with your provider; Ayushman Bharat often subsidizes.
Signs of complications?
Respiratory distress, fever, vomiting, or poor feeding.
Will my child have normal lung function?
60–80% survive; lung function varies—some need long-term support; regular monitoring is key.
Lifestyle changes post-surgery?
Monitor breathing, manage GERD, attend follow-ups (lung, development), and avoid respiratory infections.
Conclusion
CDH repair is a critical procedure to correct a life-threatening congenital defect, improving survival and lung function with intensive neonatal care. India’s top hospitals (Apollo, Fortis, AIIMS) provide affordable care, often covered by insurance or subsidized. Understanding the procedure, costs, recovery, risks, and FAQs helps caregivers approach surgery confidently. Consult a pediatric surgeon for personalized guidance.
Looking for Best Hospitals for CDH Repair
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
1,00,000 |
3,25,000 |
Ahmedabad |
1,25,000 |
3,50,000 |
Ajmer |
1,00,000 |
3,25,000 |
Aligarh |
1,00,000 |
3,25,000 |
Allahabad |
1,00,000 |
3,25,000 |
Amritsar |
1,10,000 |
3,35,000 |
Aurangabad |
1,10,000 |
3,35,000 |
Bangalore |
1,25,000 |
3,50,000 |
Bareilly |
1,00,000 |
3,25,000 |
Belgaum |
1,10,000 |
3,35,000 |
Bhopal |
1,10,000 |
3,35,000 |
Bhubaneswar |
1,10,000 |
3,35,000 |
Bikaner |
1,00,000 |
3,25,000 |
Chandigarh |
1,25,000 |
3,50,000 |
Chennai |
1,25,000 |
3,50,000 |
Coimbatore |
1,25,000 |
3,50,000 |
Dehradun |
1,10,000 |
3,35,000 |
Delhi |
1,25,000 |
3,50,000 |
Dhanbad |
1,00,000 |
3,25,000 |
Durgapur |
1,00,000 |
3,25,000 |
Faridabad |
1,25,000 |
3,50,000 |
Ghaziabad |
1,25,000 |
3,50,000 |
Gorakhpur |
1,00,000 |
3,25,000 |
Guntur |
1,10,000 |
3,35,000 |
Gurgaon |
1,25,000 |
3,50,000 |
Guwahati |
1,10,000 |
3,35,000 |
Gwalior |
1,00,000 |
3,25,000 |
Hyderabad |
1,25,000 |
3,50,000 |
Indore |
1,10,000 |
3,35,000 |
Jabalpur |
1,00,000 |
3,25,000 |
Jaipur |
1,25,000 |
3,50,000 |
Jalandhar |
1,10,000 |
3,35,000 |
Jamshedpur |
1,10,000 |
3,35,000 |
Jodhpur |
1,00,000 |
3,25,000 |
Kanpur |
1,00,000 |
3,25,000 |
Kochi |
1,25,000 |
3,50,000 |
Kolkata |
1,25,000 |
3,50,000 |
Kollam |
1,10,000 |
3,35,000 |
Lucknow |
1,10,000 |
3,35,000 |
Ludhiana |
1,25,000 |
3,50,000 |
Madurai |
1,10,000 |
3,35,000 |
Mangalore |
1,10,000 |
3,35,000 |
Meerut |
1,00,000 |
3,25,000 |
Moradabad |
1,00,000 |
3,25,000 |
Mumbai |
1,25,000 |
3,50,000 |
Mysore |
1,25,000 |
3,50,000 |
Nagpur |
1,10,000 |
3,35,000 |
Nashik |
1,10,000 |
3,35,000 |
Navi Mumbai |
1,25,000 |
3,50,000 |
Noida |
1,25,000 |
3,50,000 |
Patna |
1,00,000 |
3,25,000 |
Pune |
1,25,000 |
3,50,000 |
Raipur |
1,10,000 |
3,35,000 |
Rajkot |
1,10,000 |
3,35,000 |
Ranchi |
1,00,000 |
3,25,000 |
Surat |
1,25,000 |
3,50,000 |
Thane |
1,25,000 |
3,50,000 |
Vadodara |
1,10,000 |
3,35,000 |
Varanasi |
1,00,000 |
3,25,000 |
Visakhapatnam |
1,10,000 |
3,35,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.