Modalities of follow-up after surgical plication for diaphragmatic paralysis

Treatment of symptomatic diaphragmatic paralysis by surgical diaphragm plication provides relief to many patients, but there are no guidelines for follow-up. The aim of our study is to evaluate long-term results of diaphragm plication and to outline follow-up modalities.

We conducted a retrospective monocentric study including all the patients with unilateral diaphragmatic paralysis (UDP) consecutively operated between January 2006 and December 2021. Benefits of surgery were evaluated on dyspnea, spirometry and repeated measurements of the distance from apex to diaphragm (A-D) on chest X-ray.

A total of 23 patients were included; 60% were women. Etiology of diaphragmatic eventration was idiopathic in 14 patients (61%), iatrogenic in 3 patients (13%) and post-traumatic in 6 patients (26%). All patients had dyspnea at diagnosis with a significant reduction of vital capacity (VC) from seated to supine position, decreasing from 71.2%±18.7% to 59%±26.5% (P=0.002). All patients were operated by thoracotomy with an average hospital stay of 7.7±5 days. No postoperative mortality was observed. Median follow-up was 19 months. There was a statistically significant (P=0.001) improvement in the Medical Research Council (MRC) dyspnea score at 6 months persistent at last follow-up. VC improved from 71.2%±18.7% to 88.1%±19.4% at last follow-up (P=0.03). Chest X-ray showed a significant increase in the A-D distance from 12±3.2 to 19±2.8 cm at 6 months (P=0.001) and 17.9±3.59 cm at remote (P=0.001). A significant correlation was found between A-D distance and dyspnea, but not between X-ray measurements and VC.

Diaphragm plication effectively alleviates dyspnea in patients with diaphragmatic paralysis. Good functional results are persistent at 2 years. The correlation between chest X-ray and dyspnea suggests that these parameters may suffice for follow-up.