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Intraoperative diaphragmatic plication during initial surgery with phrenic nerve resection.

Tomomi Isono1, Mitsunori Ohta2, Ryu Kanzaki3

  • 1Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Interdisciplinary Cardiovascular and Thoracic Surgery
|September 25, 2025
PubMed
Summary

Preventive diaphragmatic plication during phrenic nerve resection may preserve lung function. This surgical technique may reduce paradoxical diaphragmatic movement and improve pulmonary function after extensive resections.

Keywords:
Diaphragm plicationLung cancerPhrenic nerveThymic tumor

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Area of Science:

  • Thoracic surgery
  • Pulmonary function
  • Diaphragmatic surgery

Background:

  • Diaphragmatic palsy can lead to respiratory failure.
  • Diaphragmatic plication can alleviate respiratory issues.
  • The efficacy of preventive plication during phrenic nerve resection is unclear.

Purpose of the Study:

  • To evaluate if preventive diaphragmatic plication during phrenic nerve resection reduces paradoxical diaphragmatic movement.
  • To assess the impact of preventive plication on postoperative pulmonary function.

Main Methods:

  • Retrospective analysis of 132 patients undergoing phrenic nerve resection.
  • Comparison of patients with and without preventive diaphragmatic plication.
  • Assessment of diaphragmatic displacement ratio (DDR) and pulmonary function (FVC, FEV1) pre- and post-surgery.

Main Results:

  • Plication was performed in 70 patients (53%).
  • In patients undergoing left lobectomy or more extensive resections, plication was associated with a smaller increase in DDR (-20.2% vs -30.1%).
  • Plication correlated with smaller declines in percent predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).

Conclusions:

  • Intraoperative diaphragmatic plication may preserve postoperative pulmonary function in specific patient groups.
  • The findings suggest potential benefits for patients undergoing left lobectomy or extensive resections involving phrenic nerve resection.
  • Further research is needed due to the study's limitations, including small sample size and generalizability concerns.