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Minimally-Invasive Diaphragmatic Plication in Patients with Unilateral Diaphragmatic Paralysis
Morris Beshay1, Mohamed Abdel Bary2, Volkan Kösek3
1Department of General Thoracic Surgery, University Hospital OWL, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany.
Journal of Clinical Medicine
|August 26, 2023
Summary
Diaphragm plication effectively treats diaphragm eventration, improving lung function and reducing shortness of breath. Minimally invasive video-assisted thoracoscopic surgery (VATS) offers better pain management and shorter hospital stays compared to open procedures.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Medical Devices
Background:
- Diaphragm eventration (DE) significantly impairs respiratory function and quality of life.
- Diaphragmatic plication (DP) is an effective, yet often underestimated, surgical intervention for DE.
- This study evaluates the efficacy of minimally-invasive DP for unilateral diaphragmatic paralysis.
Purpose of the Study:
- To assess the effectiveness of minimally-invasive diaphragmatic plication for unilateral diaphragmatic eventration.
- To compare outcomes between open thoracotomy and video-assisted thoracoscopic surgery (VATS) for DP.
- To evaluate long-term lung function improvements and complication rates.
Main Methods:
- Retrospective analysis of 134 patients undergoing diaphragmatic plication (DP) between 2008-2022.
- Patients were divided into open thoracotomy (Group I) and VATS (Group II) groups.
- Data collected included patient characteristics, lung function, surgical details, complications, and follow-up.
Main Results:
- Both open and VATS DP successfully lowered the diaphragm and improved lung function (FVC, FEV1, DLCO).
- VATS group showed significantly shorter procedure duration, hospital stay, and lower chronic pain rates.
- Minor complications were low in both groups (3% open vs. 2% VATS); no mortality observed.
Conclusions:
- Diaphragm plication is an effective treatment for diaphragm eventration, improving respiratory function and quality of life.
- Minimally invasive VATS-DP is a safe and feasible approach, superior to open surgery regarding pain and recovery.
- Careful patient selection is crucial; further prospective studies are warranted.
