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Thoracoscopic and laparoscopic plication of the hemidiaphragm is effective in the management of diaphragmatic
Jimeng Hu1, Yeming Wu, Jun Wang
1Department of Pediatric Surgery, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No 1665, Kongjiang Road, Shanghai, 200092, People's Republic of China, jimeng1214@126.com.
Insights
Minimally invasive diaphragmatic plication in children with diaphragmatic eventration offers good recovery. Different endoscopic techniques provide satisfactory outcomes, with surgeon experience guiding procedure selection.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Diaphragmatic eventration is a condition affecting pediatric patients.
- Minimally invasive surgery for diaphragmatic plication is associated with rapid recovery in children.
Purpose of the Study:
- To evaluate the effectiveness of different endoscopic plication procedures for pediatric diaphragmatic eventration.
- To provide guidance on selecting appropriate plication techniques based on surgeon experience.
Main Methods:
- Retrospective analysis of 27 pediatric patients (2 months to 3 years) undergoing diaphragmatic plication.
- Comparison of three techniques: "reefing the mainsail", "invaginating the diaphragmatic dome", and "pleating".
Main Results:
- All procedures resulted in satisfactory outcomes with significant symptom improvement.
- Postoperative diaphragm elevation averaged 2.65 intercostal spaces.
- One patient experienced pneumothorax; two patients were weaned from respiratory support within 7 days.
Conclusions:
- Endoscopic diaphragmatic plication is effective for pediatric diaphragmatic eventration.
- The choice of surgical technique is primarily based on surgeon's expertise.
- All evaluated plication methods demonstrated satisfactory clinical results.
Purpose:
Diaphragmatic plication by minimally invasive surgery is thought to allow for a quick recovery and has been performed on small children. Here, we report our experience with different plication procedures to discuss how to choose among these different plication procedures in endoscopic surgery for pediatric patients with diaphragmatic eventration.
Patients And Methods:
We retrospectively analyzed clinical data of 27 pediatric patients (21 boys, 6 girls; median age: 12.7 months, range 2 months-3 years) admitted to our hospital between November 2008 and July 2013. Three different plication procedures were used: the "reefing the mainsail" technique (8 patients), "invaginating the diaphragmatic dome" technique (10 patients), and "pleating" technique (9 patients). Indications included ventilator dependency (7.41 %), respiratory distress (22.22 %), chronic lung lobe collapse (11.11 %), persistent atelectasis with recurrent pneumonias (18.52 %), and asymptomatic severe eventration (40.74 %).
Results:
Descending distance of diaphragm after surgery ranged from 1 to 4.5 intercostal spaces (mean distance: 2.65 intercostal spaces). All patients recovered well postoperatively, except for one patient with a pneumothorax. Two patients who required respiratory support before the operation no longer required it within 7 d after surgery. Follow-up ranged from 1 to 35 months. Clinical results were satisfactory with obvious improvement in symptoms and a slight re-elevation within a distance of one intercostal space.
Conclusion:
For pediatric patients with diaphragmatic eventration, different endoscopic surgeries and plication procedures all yielded satisfactory results. We believe that the choice of one procedure over the other depends only on the surgeon's experience.
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