Diaphragmatic plication for diaphragmatic paralysis: A systematic review and meta-analysis of surgical outcomes

This systematic review and meta-analysis aims to investigate the surgical approach and outcomes of diaphragmatic plication in the setting of diaphragmatic paralysis after phrenic nerve injury. The incidence of iatrogenic diaphragm paralysis varies across different surgical procedures.

Six databases were searched from inception until February 2023 for publications reporting on diaphragm plication surgery for phrenic nerve injury. Hospital mortality was the primary outcome. Pulmonary function, return to normal breathing, survival, and radiographic or symptomatic recurrence were secondary outcomes. Factors associated with mortality and return to normal breathing were investigated.

Of 879 deduplicated papers, 96 studies were included, and a total of 1,846 patients were included. Diaphragmatic paralysis was found mostly to be unilateral and secondary to iatrogenic causes, with dyspnea being the main presenting symptom, and generally performed via a thoracotomy. Following surgical repair, our analysis showed a positive improvement in forced vital capacity and forced expiratory volume in 1 second, with more than 70% of patients returning to normal breathing. In-hospital mortality was 0.51%, and the follow-up mortality was 1.04% per person/year. With a median (interquartile range) follow-up time of 1.6 (0.9-4.5) years, follow-up recurrence was reported at a rate of 1.64% per person/year. There was a significant association between diabetes and return to normal breathing (β: 0.1103, P = .027). However, type of surgical approach was not associated with differences in outcomes.

Repair of diaphragmatic paralysis is associated with significant improvement in pulmonary function tests and minimal morbidity and mortality, independent of the chosen surgical approach.