Acquired eventration of the diaphragm--results of surgery

Results of surgical repair of acquired diaphragmatic eventration are reported. The series consists of nine adult patients studied pre- and postoperatively with clinical, radiological and lung function investigations. The repair was performed in all cases by a thoracic approach and plication of the diaphragm. The operative procedure was well tolerated in all cases. On follow-up seven patients were found to be improved and in two transient or no improvement occurred. Subjectively, gastrointestinal symptoms were alleviated most often by the operation. Radiological studies showed that although the immediate postoperative position of the diaphragm was very good in all cases, the diaphragm began to stretch and elevate gradually during the first year. In one case rupture of the repaired diaphragm developed 2 years after plication. Reoperation was performed with success. In one case the anatomical end result was no better than before the repair, in the others it was partially or completely improved. Plate atelectasis was observed no longer after the operation. Preoperative lung function studies showed a slight to moderate restrictive defect in 8 cases and a marked one in one case. 37% of the total lung perfusion was distributed to the affected side. On the average no significant changes could be found between the pre- and postoperative values.