Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery

Abstract

Diaphragm plication is used to improve lung function and respiratory insufficiency in patients suffering from diaphragm paralysis. We assessed the efficacy of intra-operative unilateral diaphragm plication for prevention of postoperative pulmonary complications in patients, who underwent a phrenicotomy due to extended surgical intervention. Intra-operative unilateral diaphragm plication was performed in 13 patients, who underwent a unilateral phrenicotomy during an extended thoracic operation. Six patients had lung cancer, six had a mediastinal tumour and one had a mesothelioma. We retrospectively observed the postoperative clinical courses in the perioperative period and lung function results at 1 year after operation. The postoperative lung function was compared with the predicted postoperative lung function. In addition, we observed clinical symptoms and radiological findings of the follow-up period. Ten (77%) of the cases revealed no postoperative complications, while three (23%) had pulmonary complications and two (15%) required prolonged mechanical ventilation. Diaphragm paralysis was not shown clinically and radiologically during the follow-up period. Postoperative lung function was similar to predicted postoperative lung function. Unilateral diaphragm plication in a patient undergoing a unilateral phrenicotomy during an extended thoracic operation is effective to prevent postoperative pulmonary complications and to preserve postoperative lung function.