Diaphragmatic Plication: Retrospective Study with 54 Patients

Abstract

Objective: This study seeks to evaluate the results of surgery performed according to the etiological causes of diaphragmatic eventration or paralysis. Method: Files of 54 patients (35 males, 19 females; mean age: 39.1 ± 3.01 years) who had undergone diaphragm plication between January 2005 and June 2011 in two clinics located in Istanbul were studied in terms of pulmonary spirometry, applied surgical procedure, duration of hospitalization, morbidity, and mortality. Results: In diaphragm plications, observed etiologies were isolated diaphragmatic eventration without phrenic nerve injury (Group 1) in 20 (37%) patients due to blunt thoracic trauma; Group 2 (thymoma in 19 (35.2%) patients; lung cancer in 7 (12.9%) patients; mediastinal tumor in 3 (5.6%) patients) and congenital heart surgery (Group 3) in 5 (9.3%) patients. The mean time to plication was 7.4 months in Group 1. The mean duration of hospitalization was 4 days in Group 1, 6.2 days in Group 2, 11.8 days in Group 3. Mean forced vital capacity, forced expiratory volume at 1 second improved by 17%, 20.3%, respectively (p < 0.005) in Group 1. In Group 1, mean dyspnea-related hospital admission before plication was 2.4 times. At the end of 6 months after plication mean dyspnea-related hospital admission was 0 time. All of them returned to daily activities or their job within 6 months in Group 1. Postoperative mortality was observed in 2 (3.7%) patients in Group 3 while the overall complication rates were 24%. The morbidity rates were 8%, 27.5%, 60%, respectively; and the mortality rates were 0%, 0%, 40%, respectively. Conclusion: As a result, it could be suggested that early and timely performed plications for diaphragmatic eventration improves functional status and assesses a shorter lenght of stay. On the other hand,simultaneously performed plications in intraoperative phrenic nerve resections can be performed with acceptable morbidity and no mortality. In diaphragmatic paralysis due to congenital heart surgery, morbidity and mortality rate is still high.

Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer

“…Consensus was reached about performing early plication for diaphragmatic paralysis in infants and young children [ 5 ]. Çelik et al suggested that early and timely plication for diaphragmatic paralysis improves functional status and shortens the length of hospitalization [ 6 ]. However, the timing of surgical plication remains controversial in adults.…”