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Plication of the diaphragm for unilateral eventration or paralysis
1Calmette Hospital, CHU, Lille, France.
Insights
Diaphragmatic plication surgery can effectively treat respiratory and digestive symptoms in infants and adults with diaphragmatic paralysis or eventration. The procedure shows durable results, improving respiratory function and patient quality of life.
Area of Science:
- Thoracic Surgery
- Pediatric Surgery
- Pulmonology
Background:
- Unilateral diaphragmatic paralysis and eventration present similarly and cause significant physiological disturbances.
- Diaphragmatic plication aims to reduce lung compression, stabilize the thoracic base and mediastinum, and enhance respiratory muscle function.
Purpose of the Study:
- To evaluate the efficacy and durability of diaphragmatic plication in pediatric and adult patients with diaphragmatic paralysis or eventration.
Main Methods:
- Surgical plication of the diaphragm was performed on 13 infants/children and 11 adults with varying degrees of respiratory and digestive compromise.
- Patient outcomes were assessed through follow-up periods averaging 6.6 years for children and 8.5 years for adults, including clinical evaluation and respiratory function tests.
Main Results:
- In pediatric patients, 9 survivors showed sustained diaphragm position and remained asymptomatic; mortality was linked to early surgery or associated conditions.
- Adult patients experienced significant symptom relief, with 9 becoming asymptomatic, 1 showing reduced dyspnea, and 1 with persistent reflux being surgically cured.
- Respiratory tests in adults demonstrated a mean improvement of 20% in vital capacity and 15% in forced expiratory volume in 1 second.
Conclusions:
- Diaphragmatic plication is a safe, effective, and durable procedure for symptomatic diaphragmatic paralysis/eventration in children and adults.
- Optimal timing for pediatric plication is after two weeks on a ventilator, with prognosis influenced by associated malformations and lung condition.
- While plication improves respiratory mechanics indirectly, its long-term effects on diaphragmatic function remain unclear.
Abstract:
Unilateral diaphragmatic paralysis and eventration have the same appearance and provoke the same disturbances. Diaphragmatic plication is intended to decrease lung compression, to make the thoracic base and mediastinum more stable, and to strengthen the respiratory action of intercostal, perithoracic, and abdominal muscles: 13 infants and children were operated upon, 7 in acute respiratory failure and ventilator-dependent, 4 in chronic respiratory failure; 11 adults were operated upon, 8 with respiratory and 3 with digestive symptoms. Four infants who had been operated upon before the 10th day of life died: 3 from associated diseases and 1 from a lung infection. The 9 survivors have been followed up for a mean period of 6.6 years. All were asymptomatic and the position of the plicated diaphragm was maintained. The 11 adults have been followed up for a mean period of 8.5 years. Nine were asymptomatic; in 1, dyspnea had decreased; in 1, reflux persisted and was surgically cured. In 5 adults, the respiratory tests showed a mean amelioration of 20% of vital capacity and 15% of forced expiratory volume in 1 s. In infants, the prognosis depends on associated malformations and on the condition of the lung. Plication should be performed after 2 weeks on a ventilator. In older children and adults, plication is justified when the anomaly produces symptoms (malignancy excluded). Plication is simple, efficient, and durable, but there is no indication of subsequent diaphragmatic function: its effects on respiratory mechanics are probably indirect.