Rare keyhole surgery at TUH heals wonder baby Madison

Madison Manners’ parents never imagined their beautiful baby girl would require surgery at just three days old and they imagined even less it would be for a rare condition that affects one birth in 30,000. 

But this is exactly what happened as Townsville University Hospital (TUH) paediatric surgeon Dr Bhanu Rathnamma undertook the delicate task of repairing Madison’s malfunctioning diaphragm, the muscle that separates the chest from the abdomen.

Known as diaphragmatic eventration, the condition causes compression of the lungs, breathing difficulties, and alters the positioning of other organs in the chest, including the heart.

Dr Rathnamma performed the repair using keyhole technique known as thoracoscopic surgery, a surgery rarely done outside Brisbane, sparing Madison from having her chest cavity opened and a longer, more painful recovery.

Now at just two weeks old, Madison is home with parents Jane Blackbourn and Laurence Manners in Bowen and the tiny incisions from the keyhole surgery are almost a distant memory.

Ms Blackbourn said the first sign anything was wrong with Madison was picked up at a 20-week pregnancy scan.  

“At the scan, the ultrasound picked up some abnormalities in Madison’s right diaphragm and our obstetrician then referred us to fetal maternal medicine specialist Dr David Watson and the maternal fetal medicine service,” Ms Blackbourn said. 

“Madison is our first child, and it was very stressful and scary to find out about her condition, especially because it wasn’t something we had heard of and we didn’t know what treatment options were available in Townsville. 

“Dr Watson and the clinic were great, they had to deliver some terrible news to us, and it wasn’t a nice experience to go through; but the team was excellent at explaining everything before we transitioned to Dr Rathnamma for the surgery.”

Dr Rathnamma said a chest x-ray and ultrasound after Madison’s birth confirmed the eventration.

“This is an uncommon condition which looks similar to a diaphragmatic hernia in the initial scans,” Dr Rathnamma said.

“For this reason, we had to wait for the x-rays and ultrasounds after Madison was born to confirm the diagnosis which led to the decision to perform the keyhole surgery. 

“Performing the surgery this way was advantageous because it is less painful, there are no scars and Madison was able to be discharged much earlier. 

“I’ve performed this keyhole procedure on older children before, but never on a three-day-old baby, and I am so proud of the outcomes we’ve been able to achieve for Madison and her family.”

Dr Rathnamma said typically, the surgery for the eventration would be an open operation requiring a cut down the chest wall.

“This takes a long time to heal, has a longer hospital stay, is very painful, leaves a bad scar, and eventually leads to chest wall deformities and chest asymmetry as a child grows,” he said.

 “We were able to avoid all these problems for Madison by doing this operation by the keyhole technique.”

 Maternal fetal medicine specialist Dr David Watson said diaphragmatic eventrations only presented every few years.  

“A diaphragmatic eventration is very rare condition, affecting only one in 30,000 births in North Queensland,” Dr Watson said.

“Congenital diaphragmatic hernias are still rare but more common than the eventration and to diagnose the condition we usually notice the displacement of the liver or the stomach up into the chest cavity and the heart is sometimes displaced.

“This is a major abnormality that can be life-threatening for the baby once they are born, but the paediatric surgical management is life-saving.

“It’s very helpful to be able to tell parents there is a repair that can be done through a keyhole procedure, which has a much better recovery for the baby.”

 Ms Blackbourn said Madison had been wonderful post-surgery. 

“Following the surgery Madison spent two days in the neonatal intensive care unit before we moved to special care and were then discharged on the Sunday,” she said. 

“This is incredible considering she had the surgery on the Wednesday.

“We can’t thank all of the doctors, nurses and midwives enough. We were kept informed the entire time, learnt so much from everyone, and every single person involved in our care has been amazing.”

Dr Rathnamma said being able to provide this high-quality care for children in North Queensland was incredible.

“The best thing for Madison is that she received the world-class treatment, comparative to what she would have received at the best of the best children’s hospitals across the globe,” he said. 

“What we achieved was only possible because of our teamwork.

 “We have excellent maternal fetal services, neonatal intensive care unit and neonatal anaesthesia teams, and together we are all here to do our absolute best for kids in North Queensland.”

To support families like Madison’s, you can donate to the Townsville University Hospital’s foundation, Brighter Lives, by visiting here.