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Video-assisted diaphragm plication in children
1Department of Cardiothoracic Surgery, Brenner Children's Hospital, Wake Forest University/Baptist Medical Center, Winston-Salem, North Carolina 27157, USA. mhines@wfubmc.edu
Insights
Video-assisted plication effectively treats diaphragm paralysis in pediatric patients, offering faster recovery and fewer complications than open surgery. This minimally invasive approach improves respiratory function and outcomes.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Surgery
- Minimally Invasive Procedures
Background:
- Diaphragm paralysis post-cardiac surgery can stem from phrenic nerve injury.
- While often asymptomatic, it can cause significant respiratory issues, especially in children.
- Video-assisted plication presents a potentially faster recovery alternative to thoracotomy for pediatric cases.
Purpose of the Study:
- To evaluate the efficacy and safety of video-assisted plication for diaphragm paralysis in pediatric patients.
- To compare recovery times and morbidity with traditional open surgical techniques.
Main Methods:
- Five video-assisted plication procedures were performed on infants and children.
- The technique involved elevating, clamping, oversewing, and tacking the diaphragm.
- Indications included ventilator dependency, post-surgical complications, and congenital eventration.
Main Results:
- Ventilator-dependent patients were extubated within 2-3 days; others were extubated immediately.
- Most patients experienced rapid recovery, with some discharged within days.
- Successful diaphragm flattening and lung reexpansion were observed, with no procedural complications.
Conclusions:
- Video-assisted plication is a safe and effective treatment for paralyzed diaphragms in children.
- It demonstrates reduced morbidity and quicker recovery compared to open surgical methods.
- The procedure leads to successful diaphragm function restoration and improved respiratory outcomes.
Background:
Diaphragm paralysis after cardiac surgery may be secondary to phrenic nerve injury by ice, electrocautery, or dissection. Although most are asymptomatic, some patients, particularly children, have significant respiratory compromise. Video-assisted plication may offer more rapid improvement and recovery than thoracotomy in pediatric patients.
Methods:
We performed five procedures. The diaphragm was elevated, clamped, oversewn, and tacked down into the pleural gutter. The procedure was performed on 2 infants after repair of total anomalous pulmonary venous connection, on 1 child after the Fontan procedure, on 1 child after repair of tetralogy of Fallot, and on 1 child with congenital eventration. Indications included ventilator dependency, post-Fontan protein losing enteropathy with elevated venous pressures and chronic right lower lobe collapse, persistent atelectasis with recurrent pneumonias, and asymptomatic severe eventration.
Results:
Ventilator-dependent patients were extubated after 2 and 3 days. The remaining patients were immediately extubated. One patient was discharged the day of surgery and 2 were discharged at 1 and 3 days postoperatively. The remaining 2 were discharged on postoperative day 30 and 45 after continued issues with feeding and prematurity. The child with the eventration had rapid expansion and growth of the left lung over the next few weeks with a normal chest radiograph 3 weeks later. The child with recurrent pneumonia reexpanded her left lower lobe and remains free of infection. There were no wound infections, lung or vascular injuries, or complications from the procedure. All the patients had successful flattening of the hemidiaphragm as documented by chest radiograph, with successful lung reexpansion.
Conclusions:
Video-assisted plication of paralyzed diaphragms is effective and safe, involves less morbidity, and has quicker recovery times than traditional open techniques.
