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Diaphragmatic eventration in infants and children: is conservative treatment justified?
C Tsugawa1, K Kimura, E Nishijima
1Department of Surgery, Kobe Children's Hospital, Japan.
Insights
Diaphragmatic plication effectively treats diaphragmatic eventration caused by phrenic nerve injury or congenital muscular deficiency. Surgical repair offers rapid respiratory improvement for symptomatic patients.
Area of Science:
- Thoracic Surgery
- Pediatric Surgery
- Pulmonology
Background:
- Diaphragmatic eventration presents significant respiratory challenges in pediatric patients.
- Causes include phrenic nerve injury (PNI) and congenital muscular deficiency (CMD).
- Surgical intervention is considered for both symptomatic and asymptomatic cases to ensure optimal lung development.
Purpose of the Study:
- To evaluate the efficacy and justification of diaphragmatic plication for treating diaphragmatic eventration.
- To assess outcomes in patients with PNI and CMD.
Main Methods:
- Retrospective review of 50 patients (4 days to 7 years old) who underwent diaphragmatic plication.
- Patients were categorized into PNI (n=25) and CMD (n=25) groups.
- Diaphragmatic plication was performed via a thoracic approach using reefing mattress sutures.
Main Results:
- Significant improvement in respiratory status post-operation, with rapid discontinuation of ventilatory support (mean 3 days) in PNI patients.
- Two patients required reoperation due to insufficient plication tightness.
- No deaths were attributed to the diaphragmatic plication procedure itself.
Conclusions:
- Diaphragmatic plication is a highly effective treatment for symptomatic diaphragmatic eventration.
- Immediate surgical repair is recommended for symptomatic patients to achieve dramatic resolution of respiratory issues.
- The procedure is safe and beneficial for improving respiratory function and supporting lung growth.
Purpose:
The purpose of this study is to examine the justification of diaphragmatic plication to treat diaphragmatic eventration. A retrospective review of 50 patients who underwent diaphragmatic plication for phrenic nerve injury (PNI) or congenital muscular deficiency (CMD) of the diaphragm was conducted.
Methods:
During the last 26 years, 50 patients, aged 4 days to 7 years, were surgically treated for diaphragmatic eventration. Twenty-five patients had iatrogenic PNI and another 25 had CMD. Respiratory distress developed in all patients who had PNI and 10 required mechanical ventilatory support for 13 to 78 days (mean, 41 days) before operation. Respiratory symptoms developed in 17 of 25 patients who had CMD, and four required ventilatory support. In those who were asymptomatic, we justified surgical repair to optimize future lung growth. All patients underwent diaphragmatic plication by a thoracic approach. Reefing mattress sutures on pledgets were used for the plication.
Results:
In patients who had PNI, ventilatory support could be discontinued within 0 to 6 days (mean, 3 days) after operation, with a dramatic improvement in their respiratory status. Two patients required reoperation because the plication was not tight enough. Seven patients died in this series, but none because of the diaphragmatic plication.
Conclusion:
This study suggests that symptomatic patients who have diaphragmatic eventration should be operated on immediately with an expected dramatic resolution of their respiratory problems.