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Phrenic Nerve Reconstruction and Bilateral Diaphragm Plication After Lobectomy
Shuichi Shinohara1, Tetsu Yamada1, Mitsuhiro Ueda1
1Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan.
The Annals of Thoracic Surgery
|June 22, 2017
Summary
This study details a successful phrenic nerve reconstruction in a patient with diaphragm paralysis. The surgical intervention restored diaphragm function, enabling ventilator weaning and patient discharge.
Area of Science:
- Thoracic surgery
- Neurosurgery
- Diaphragm reconstruction
Background:
- Phrenic nerve paralysis can result from thoracic surgeries, impacting diaphragm function.
- Mediastinal tumor resection is a known cause of phrenic nerve injury.
- Diaphragm paralysis significantly affects respiratory mechanics and patient outcomes.
Observation:
- A 49-year-old male presented with a history of left phrenic nerve paralysis and a newly discovered right upper lobe lung nodule.
- The patient underwent right upper lobectomy, during which the right phrenic nerve was inadvertently severed.
- The severed right phrenic nerve was surgically reconstructed, and bilateral diaphragm plication was performed.
Findings:
- Postoperative recovery included successful weaning from mechanical ventilation on postoperative day 13.
- Chest fluoroscopy at three months demonstrated restored movement of the right diaphragm.
- Nerve conduction studies confirmed functional improvement in the reconstructed right phrenic nerve.
Implications:
- Phrenic nerve reconstruction is a viable option for managing diaphragm paralysis after thoracic surgery.
- Restoration of diaphragm function can lead to improved respiratory outcomes and patient recovery.
- This case highlights the potential for successful surgical management of complex iatrogenic nerve injuries.
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