[Thoracic Surgical Management of Unilateral Symptomatic Diaphragmatic Paralysis: Consensus Statement of an Expert...

Surgical correction of unilateral diaphragm paralysis is performed in many hospitals with a small number of cases. A randomised study or a guideline on this topic does not exist. The aim of the present consensus search was to develop uniform minimum requirements for the diagnosis, surgical therapy, and postoperative management of unilateral diaphragm paralysis, in order to improve the quality of care for this rare disease.In a structured, modified Delphi process, experts from the German Society for Thoracic Surgery (DGT) were interviewed on the surgical management of unilateral symptomatic diaphragm paralysis and recommendations were extracted with an agreement rate of ≥ 80%. All heads of thoracic surgery departments whose clinics were certified as lung cancer centres by the German Cancer Society were specifically included.After 2 online Q&A sessions and a working meeting of the experts, 14 recommendations for the surgical management of unilateral symptomatic diaphragm paralysis were agreed: For diagnostic purposes, a CM-CT of the neck and thorax and, if there are indications of obstructive sleep apnoea, a sleep laboratory diagnostic test should be performed. The indication for surgical diaphragmatic plication is based on the combination of diaphragmatic elevation, specific symptoms, and the presence of functional limitations. The use of the Diaphragm Paralysis Questionnaire (DPQ) is recommended. If there are indications of cervical disc herniation, the success of local treatment should first be awaited. In the case of unclear diaphragmatic paralysis, a waiting period of at least 6 months should be observed between the onset of symptoms and surgery. The operation should be minimally invasive without a diaphragmatic resection and adhesions should be adequately removed. Reinforcing suture patches should be used with the contraction sutures and an artificial mesh should be used according to the surgeon's assessment. One drainage tube is sufficient. Postoperative mobilisation and weight-bearing should be specifically adapted, but should take place early in the hospital after lung resection. A symptom-oriented follow-up examination is recommended after 6-12 months.14 minimum standards for the surgical management of unilateral diaphragm paralysis were agreed upon. These are recommended to the members of the DGT.