[Diaphragmatic eventration in adults. Apropos of 20 cases]

Twenty adults with a mean age of 49 were operated on between 1972 and 1980 for eventration of the diaphragm. The etiology was probably traumatic in 11 cases; it was congenital in 2 and degenerative in 7. The functional signs were usually respiratory (55%) or digestive (10%). In all cases, the diagnosis was based on standard fluoroscopy showing superelevation of the hemidiaphragm, which was visualized fluoroscopically as immobile while a pneumoperitoneum showed a absense of any tear. Spirography confirmed a restrictive deficit which was sited broncho-spirometrically on the eventration side. Surgical repair was achieved in most cases by thoracotomy (19 cases) and consisted in plication (17 cases) or incision followed by suturing of the overlapping edges of the muscle (3 cases). Postoperative complications included the death of the patient with multiple trauma, on the eight postoperative day, as a result of the cerebrovascular accident, and in another case rutpure of the repair on the second day, requiring a second operation. Apart from one patient who died as a result of a fatal accident two years postoperatively, all the surgically treated cases are alive, and, with one exception, symptom free. After an average follow up period of 2 years and 2 months, the control respiratory function tests show a 21% improvement in vital capacity and a 20% increase in FEV1. On the basis of these results, the authors conclude that this functional surgery is justified in the case of patients presenting with typical clinical symptoms, and worth considering in cases where respiratory function tests show a restrictive deficit, but also in patients who do not complain of breathlessness.