Hypoplasia Surgery: Everything You Need to Know

Surgery to repair incomplete organ or tissue development

Closeup of a cardiac monitor

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Hypoplasia surgery can include a number of different surgical interventions aimed at rectifying hypoplasia—which is incomplete development of an organ in the body. While hypoplasia is usually congenital and can involve any part of the body, corrective surgery is most frequently used to treat hypoplasia of the heart, blood vessels, lungs, or gastrointestinal (GI) system. Typically, these procedures are done during childhood, and optimal correction might involve more than one separate operation.

What Is Hypoplasia Surgery?

There are many types of hypoplasia surgery, with methods that may include restructuring underdeveloped organs or transferring tissue from another area of the body to the underdeveloped organ.

Hypoplasia is often a feature of congenital syndromes that involve multiple structural defects. For example, congenital heart disease can involve a few anatomical abnormalities, and hypoplasia may be one of several coexisting problems. In these situations, the corrective procedure may involve hypoplasia repair as well as other surgical interventions at the same time.

Hypoplasia surgery may be minimally invasive, or it might be done as an open procedure. This surgery can be done as an outpatient procedure or it may require staying in the hospital for several days. Typically, hypoplasia surgery requires pain control with general anesthesia.

Contraindications

There are several situations in which hypoplasia surgery might not be the right option. If the defect can't be surgically corrected, or if surgery would pose a life-threatening risk due to underlying health issues, then hypoplasia surgery would be contraindicated.

And sometimes the procedure has to be delayed until a target milestone is reached. For example, if a child's anticipated growth would alter the anatomical correction of hypoplasia surgery, the surgery might be postponed until the child has reached a certain size that would be considered optimal for surgery.

Also, an acute illness, like severe infection or respiratory distress, may need to be fully treated before surgery can proceed.

Potential Risks

This surgery involves the risks that are normally associated with general anesthesia and surgery. Additionally, hypoplasia surgery can cause additional complications.

Risks of hypoplasia surgery include:

  • Excessive bleeding
  • Inadequate healing
  • Organ damage
  • Post-operative infection
  • Blood clots

Sometimes complications of hypoplasia surgery can cause noticeable symptoms, like swelling or pain. But surgical complications don't always cause immediately obvious effects and might be detected with postoperative imaging studies or other diagnostic tests.

Purpose of Hypoplasia Surgery

Hypoplasia surgery is done to alleviate the effects of hypoplasia, which can range from negligible to life-threatening. The impact of hypoplasia is determined by which part of the body is underdeveloped, and what type of alterations in physical function occur as a result of the underdevelopment.

Generally, specific parts of an organ, such as the valves of the heart or the blood vessels of the lungs, are more likely to be affected by hyperplasia than other regions of the organ.

Hypoplasia is similar to dysplasia (abnormal growth of an organ or tissue) such as bone dysplasia and aplasia (lack of an organ) like partial skin aplasia.

A few types of hypoplasia that can be surgically treated include:

Symptoms of hypoplasia of the heart and lungs can occur during infancy and may include pale, bluish skin and lethargy. Hypoplasia affecting organs of the GI system can cause abdominal distension (enlargement), vomiting, and inadequate growth.

Sometimes hypoplasia of the ovaries or testes might not be detected until late childhood due to the absence of signs of puberty. And these issues may lead to infertility if they aren't treated.

And hypoplasia may cause physical deformities in a person's appearance, such as an uneven appearance of the face or short stature.

Depending on the extent of underdevelopment, some types of hypoplasia can be completely corrected, but often, the underdeveloped organ cannot be made like a fully formed organ. Some defects might remain, even after several corrective surgeries.

How to Prepare

Hypoplasia surgery is a major procedure that requires detailed planning. Ultrasound testing during pregnancy can detect some forms of hypoplasia, and some types of hypoplasia surgery are performed shortly after the birth of the baby.

Surgical preparation involves diagnostic tests that assess the structure and function of the affected organ.

An echocardiogram might be used to examine the heart's anatomy prior to surgery. And an ultrasound or computerized tomography (CT) scan might be used to visualize the abdominal organs. Additionally, an evaluation to identify commonly associated anatomical malformations might be carried out as well. The can include imaging tests or blood tests.

As part of pre-anesthesia and presurgical testing, a complete blood count (CBC), blood chemistry tests, and a chest X-ray will be done.

Location

Hypoplasia surgery is done in a hospital operating room or in a surgical center operating room.

What to Wear

If your child is having hypoplasia surgery, they can wear anything comfortable for the surgery appointment. They will need to wear a hospital gown during surgery.

Food and Drink

It is necessary to abstain from food and drink after midnight on the night before surgery.

Medications

Medication instructions are specific to the type of surgery. Sometimes medication is needed to stabilize the medical condition or to prepare for surgery.

What to Bring

Be sure to bring an identification form, health insurance information, and payment for any portion of the surgery that you are responsible for. Someone needs to be available to drive the patient home upon discharge after surgery.

Pre-Op Lifestyle Changes

Depending on the type of surgery, some dietary restrictions or activity restrictions may be needed in the days or weeks before surgery.

What to Expect on the Day of Surgery

When you or your child goes to the surgery appointment, you need to register and sign a consent form. Before surgery, the patient will go to a pre-operative area. If your young child is having surgery, you might be able to go to the pre-operative area with them.

Preparation includes checking temperature, pulse, blood pressure, respiration, and oxygen level. An intravenous (IV, in a vein) line is placed in the hand or arm.

The surgeon and anesthesiologist may examine your child right before surgery. And same day pre-operative tests like CBC, blood chemistry tests, and urinalysis might be done. If these tests show an acute issue, like an infection, that might mean that surgery will be postponed until the issue is treated.

Before the Surgery

Before surgery begins, the skin is prepared and cleaned, and anesthesia is started. A urinary catheter might be placed as well.

The anesthetic medication is injected into the IV line. This medication controls pain, paralyzes the muscles, and induces sleep. Your child will have a breathing tube placed into their throat for mechanical breathing assistance during surgery.

The surgical area is covered with a surgical drape, with exposure of the area where the surgical incision will be placed in the skin. The skin is cleansed with a disinfectant solution in preparation for surgery. If tissue will be removed from another area of the body for the repair, then all areas where there will be a skin incision will be draped and cleansed.

During the Surgery

Surgery is started when the surgeon makes an incision into the skin. Then a deeper incision is made into the mesothelium, which is a layer of tissue that encloses the organs of the chest, abdomen, and pelvis. Then the surgeon will access the organ that's affected by hypoplasia for the surgical repair.

There are many surgical techniques used during hypoplasia surgery, involving a variety of methods and steps.

For example:

  • A procedure used to repair hypoplasia of the heart might involve correcting underdeveloped heart valves or blood vessels.
  • Procedures for repairing intestinal hypoplasia might involve the creation of connections or opening the lumen of the intestines.
  • Surgery for hypoplasia of the kidneys might involve transferring blood vessels to the kidney from elsewhere in the body.

After the underdeveloped organ is operated on, the surgeon will close the mesothelium and the skin, and cover the wound with surgical dressing.

The anesthesia will be stopped and the breathing tube removed. The anesthesia team will ensure that the patient is breathing independently before moving to the post-operative recovery area.

After the Surgery

You might be able to be with your child in the recovery area. Your child will be groggy and will slowly wake up. If they have a urinary catheter, it will be removed. Your child may be able to start eating and drinking. If they are old enough to use the toilet on their own, they will be able to do so with assistance.

Sometimes patients are discharged to go home on the day of hypoplasia surgery. And often, patients need to stay in the hospital for one or more days for post-operative testing. For example, a child who has had intestinal surgery might have abdominal imaging studies, and a child who has had heart surgery might have an echocardiogram.

Upon discharge, you will receive guidance regarding diet, activity, wound care, signs of surgical complications, and special instructions. You will also have a follow-up appointment with the surgeon.

Recovery

Recovery varies, depending on the type and extent of hypoplasia surgery. Sometimes surgery can help a person have completely normal functioning after healing, and sometimes hypoplasia surgery partially improves function.

You and your child will have to get used to the new way your child's body is working. This might mean being able to eat without pain, run without getting short of breath, or a variety of other outcomes.

Healing

After surgery, healing may take several weeks or months. As the surgically repaired or restructured tissue heals, your child might need to limit certain activities. Limitations are based on the type of surgery.

GI surgery often requires dietary modification, and cardiac surgery might require limited physical strain. Your child's doctor will provide guidance regarding what activities should be avoided during the healing stage.

Sometimes pain medication is needed to control pain. And keeping the wound clean, dry, and changing dressings as directed is important for proper healing.

Signs of surgical complications include:

  • Fever
  • Pain
  • Irritability or unusual behavior
  • Vomiting
  • Shortness of breath
  • Pale, or bluish skin
  • Lethargy or excessive sleeping

Be sure to discuss any concerning signs with your child's doctor.

Coping With Recovery

Sometimes children may have a brace or bandages during recovery. This can be annoying, especially for young children who are starting to become mobile. Parents need to pay attention to keeping the brace in place and helping to minimize discomfort.

Recovery might involve interventions like physical therapy or cardiac or respiratory rehabilitation.

Long Term Care

Often, congenital problems involve more than just correctable structural issues. Depending on the medical condition, your child might need to have follow-up imaging studies to monitor for new problems that are expected to develop years after the hypoplasia surgery.

Your child might have a medical syndrome that requires treatment with prescription medication for several years, or for the rest of their life.

And some congenital syndromes that cause hypoplasia might be associated with medical concerns like an immune deficiency that requires special attention as well.

Possible Future Surgeries

Often hypoplasia repair is one step along the path of a series of surgical procedures that will take place over time. Your child may need to have another procedure when certain milestones are met—such as healing after surgery or reaching a certain age or weight.

If your child is old enough to understand, they might have questions about each individual procedure and the different objectives of each surgery. Your child's doctors will be able to explain these things to you and your child in a way that they can understand.

Lifestyle Adjustments

Over time, healing should improve your child's quality of life. But there may be some limitations due to the underlying medical illness that you and your child need to adjust to.

A Word From Verywell

Hypoplasia surgery can improve a child's quality of life. And for some congenital conditions, it can be lifesaving. Repair of hypoplasia might involve a multistep process, with several sequential surgical operations. Since this surgery is usually done during early childhood, parents need to take on the responsibility of postoperative care as kids heal and recover after hypoplasia surgery.

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