A few weeks after their premature arrival at a hospital in George and a nerve-racking mercy flight to a Cape Town hospital, twin boys Sylis and Leo are safely settled in their family home with their parents, Lulani Speed and Jacques Labuschagne.
Born nine weeks early, on March 21, Sylis and Leo each weighed a mere 1,645 grams. But their early arrival, at just 30 weeks and 6 days’ gestational age, was only the first hurdle. Their mom, Speed, 34, recalls the frantic rush to the hospital in George after her waters broke unexpectedly on the morning of March 16. “The contractions started a few days later, and it became clear the twins were ready to arrive, and they were delivered by emergency C-section,” she said.
The joy of their birth was quickly overshadowed when X-rays revealed that Sylis had a life-threatening left-sided congenital diaphragmatic hernia (CDH). This was crushing news for Speed and her husband, Labuschagne.
Sylis was immediately stabilised and airlifted to Netcare N1 City Hospital in Cape Town. The following day, Leo and Speed joined him, reuniting the twins as they faced an uncertain future.
Neonatologist Dr Ricky Dippenaar explained the gravity of Sylis's condition: “This life-threatening defect meant that a hole in his diaphragm had caused his abdominal organs — including his stomach, liver and spleen — to push into his chest cavity. The diaphragmatic hernia compressed Sylis's lungs, hindering their development and causing pulmonary hypertension. His little heart, forced to the other side of his chest, was under immense strain.
“With this condition, our priority is always to stabilise the baby. Only when our multidisciplinary team, which includes a paediatric surgeon, neonatologist and anaesthetist, agrees that the infant is strong enough for the physiological demands of anaesthesia and surgery, do we consider moving forward. The pace of this process is entirely dictated by the needs of our little patients,” Dippenaar added.
Paediatric surgeon Dr Shamaman Harilal, who led the surgery on Sylis, explained the critical first steps in his care during which the baby adjusts to life outside the uterus, or from foetal to external circulation.
“In the past, before we understood the dynamics, we would operate much earlier on these little babies, but nowadays we understand the importance of timing better, and we generally wait for 48 to 72 hours before operating. What made this case somewhat unique for us was that we managed to stabilise the infant relatively quickly, on the third day after he was born.”
“Dr [Shamaman] Harilal's decision to perform minimally invasive 'keyhole' surgery to repair Sylis's hernia thoracoscopically was nothing short of brilliant. While this innovative technique was a first for the Western Cape, he drew on prior experience from his time in KwaZulu-Natal to ensure the safest and most beneficial approach for Sylis, who met the criteria for this less invasive procedure,” Dippenaar added.
Harilal explained the technique's benefits: “Instead of a large surgical incision, we repaired the defect using one half-centimetre and two small, three-millimetre incisions in the chest wall. This less invasive approach translates to less post-operative pain and a reduced need for pain relief medication. In addition, it avoids having to cut through the chest cavity, averting the possibility of spinal curvature known as scoliosis. Similarly, by not cutting through the abdomen, the risk of abdominal complications is reduced.
“Once I assessed the chest space, we inflated the chest cavity using minimal pressure, and with the aid of manipulation tools, I gradually directed the stomach and intestines back into the abdominal cavity.
Thereafter, several sutures were used to close the defect. Fortunately, Sylis had sufficient muscle and did not need a patch.
“Since arriving in Cape Town in March 2022, I've been struck by both the challenges and the opportunities to advance neonatal care. Performing this procedure for the first time in the Western Cape wouldn't have been possible without the dedication and expertise of our entire team. Moving forward in medicine requires the commitment of everyone involved, from the anaesthetist and nursing staff to the neonatologist.
“It's through this collaborative spirit that we can take things to the next level and offer the best possible care to our patients. I am particularly thankful for the support of Dr Dippenaar and my colleagues, Professor Sidler and Professor Brown and the team at Netcare N1 City and Netcare Blaauwberg Hospitals,” Harilal said.
Reflecting on Sylis's remarkable recovery, Dippenaar said, “It was pretty amazing to watch Dr Harilal repair the hernia with such precision, and then to witness the baby's body adapt and heal. After the procedure, Sylis returned to the neonatal ICU and remained on a ventilator while we stabilised him postoperatively, managing his pain and ensuring his comfort.
“His breathing tube was removed 48 hours after surgery, and he was transitioned to non-invasive respiratory support, with gradual weaning from oxygen over the following weeks. This is necessary because his left lung was considerably smaller and underdeveloped, requiring his body to adapt. We must also remember that Sylis and his brother Leo were nine weeks premature and had to learn how to feed before they could be safely discharged from the hospital.
“Sylis's diaphragmatic hernia repair highlights the advances in technology and skills. However, it is crucial to remember that many CDH cases can be incredibly challenging to manage. A successful outcome often depends on the type of hernia, its size, any associated problems and the initial course of stabilisation before surgery. Any parent who has been informed that their unborn child has a congenital diaphragmatic hernia needs extensive counselling, not only by the paediatric surgeon but also from the neonatal team who will be caring for the baby following delivery and before and after surgery,” Dippenaar explained.
Speed and Labuschagne are overwhelmed with gratitude for the unwavering dedication of the medical team. “The doctors and NICU staff were absolutely amazing and we can never thank them enough for their expertise and compassion,” said Speed.
When asked what she most looked forward to upon arriving home in George, Speed's answer is simple, heartfelt and brimming with anticipation: “I just want to hug our three dogs. We're so happy and excited to begin this new journey as a family, finally together.”
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