Diaphragmatic Incisions Guided by Nerve Stimulator:A Respiratory Study

Abstract

Thirty-four patients with hiatus hernia, divided into two groups, were operated upon by the transthoracic and transdiaphragmatic approach. In half of the patients (group I), the diaphragmatic incisions were made without the guidance of the nerve stimulator. In the other half (group II), the line of diaphragmatic incisions was guided by the nerve stimulator in order to avoid injury to the phrenic nerve. The pre- and postoperative respiratory function, arterial blood gas tensions, and diaphragmatic functional tests were statistically analysed in both groups. In group I, significant reductions in regional ventilation, perfusion and volume of the left lung, particularly the left basal field, were associated with a high incidence of diaphragmatic paralysis (10/17). Application of the nerve stimulator in group II resulted in significant improvement in the regional lung function after surgery and the diaphragmatic paralysis could be almost avoided (1/17). No statistical differences in the spirometric values coul...