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Outcomes After Pediatric Diaphragmatic Plication: Open Versus Minimally Invasive Approaches.

Megan Z Chiu1, Donna C Koo1, Steven J Staffa2

  • 1Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States.

Journal of Pediatric Surgery
|September 15, 2025
PubMed
Summary

Minimally invasive diaphragm plication surgery shows lower recurrence rates than open approaches. The choice of surgical method depends on concurrent procedures, with an individualized approach recommended.

Keywords:
Diaphragm eventrationDiaphragm plicationLaparoscopicLaparotomyMinimally invasive surgeryPediatricThoracoscopicThoracotomy

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Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Surgical Outcomes

Background:

  • Diaphragmatic eventration is a condition requiring surgical intervention, typically diaphragm plication.
  • Surgical approaches include laparoscopic, thoracoscopic, open transabdominal, and transthoracic methods.
  • Patient comorbidities significantly influence surgical planning and outcomes.

Purpose of the Study:

  • To evaluate the outcomes of diaphragm plication procedures at a single institution.
  • To compare the effectiveness of different surgical approaches for diaphragm plication.
  • To identify factors associated with recurrence and mortality after diaphragm plication.

Main Methods:

  • A retrospective review of 38 patients who underwent 43 diaphragm plication procedures between 2012 and 2022.
  • Analysis of preoperative, intraoperative, and postoperative data using nonparametric methods and regression analysis.
  • Comparison of outcomes across laparoscopic, thoracoscopic, open transabdominal, and transthoracic approaches.

Main Results:

  • Nearly all pediatric patients (37/38) had significant comorbidities.
  • Concurrent cardiac or tracheoesophageal surgery was linked to open transthoracic approaches.
  • Minimally invasive approaches demonstrated significantly lower recurrence rates (0%) compared to open approaches (25%).

Conclusions:

  • Minimally invasive diaphragm plication is associated with a reduced risk of recurrence requiring reintervention.
  • The need for concurrent procedures influences the selection of surgical approach.
  • An individualized surgical strategy prioritizing minimally invasive methods is recommended, considering prevalent comorbidities.