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 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.
Highlights
The diaphragm is an anatomical structure consisting of two dome-shaped muscles and an aponeurosis separating the abdomen and the thorax
Records of patients that had undergone diaphragm plication for diaphragmatic eventration or paralysis between January 2005 and June 2011 at Istanbul University, Istanbul Medical Faculty, Thoracic Surgery Department and Medicana Hospital’s Thoracic Surgery Department in Istanbul were studied retrospectively in terms of pulmonary spirometry, applied surgical procedure, duration of hospitalization, morbidity, and mortality and divided into three groups according to etiologies
Sternotomy was performed under general anesthesia, while diaphragm plication was performed during single lung ventilation by right or left mini-lateral thoracotomy through the 8th intercostal space and by bilateral mini-lateral thoracotomy through the 8th intercostal space in those having a history of congenital heart surgery
Summary
The diaphragm is an anatomical structure consisting of two dome-shaped muscles and an aponeurosis separating the abdomen and the thorax. The main anatomical function of the diaphragm is to separate the thoracic and abdominal cavities; its main physiological function is its role in ventilation. Diaphragmatic eventration or paralysis observed in adults is rarely observed. Cardiothoracic surgery, mediastinal pathologies, thymus surgery, tumors, infections, muscle-nerve disease, thoracic and mediastinal radiotherapy, injuries, and granulomatous diseases are the most frequent reasons for diaphragmatic paralysis [2,3,4]. Paralysis of diaphragm is a severe complication of cardiothoracic surgery carrying significant morbidity and mortality [5]. The aim of the study is to evaluate the results of surgery performed according to the etiological causes of diaphragmatic eventration or paralysis
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