Laparoscopic Diaphragmatic Plication in Patients with Unilateral Diaphragm Paralysis with Thoracoscopic Verification

Willem N Welvaart,Marinus A Paul,Kieng H Ong,Coen A C Ottenheijm,Anton Vonk-Noordegraaf

doi:10.4236/ojts.2012.24021

Abstract

Diaphragm eventration or paralysis causes elevation of the ipsilateral diaphragm. Some patients have symptoms. The most common symptom is dyspnea. In symptomatic patients with unilateral diaphragm paralysis and dyspnea disproportionate to the degree of physical activity, diaphragm plication is the treatment of choice to relieve dyspnea. We report on our experience with laparoscopic plication of a paralysed hemidiaphragm. The laparoscopic approach is an attractive surgical alternative for the treatment of phrenic nerve palsy. This technique combines the advantage of an excellent field of vision during surgery with a fast postoperative recovery and early discharge from hospital. In accordance to recent literature, we have successfully applied the laparoscopic approach to treat our patients who suffered from a unilateral paralysis of the diaphragm. Preoperative symptoms of exertional dyspnea and orthopnea were significantly reduced.

Highlights

An elevated diaphragm due to paralysis is an uncommon condition
In symptomatic patients with unilateral diaphragm paralysis and dyspnea disproportionate to the degree of physical activity, diaphragm plication is the treatment of choice to relieve dyspnea
In accordance to recent literature, we have successfully applied the laparoscopic approach to treat our patients who suffered from a unilateral paralysis of the diaphragm

Summary

Introduction

An elevated diaphragm due to paralysis is an uncommon condition It may be an incidental finding in asymptomatic patients, but sometimes it is the cause of orthopnea and dyspnea on excertion. In the latter patients the clinical condition can be improved by plication, limiting the paradoxal movement on respiration. A recent patient, who became symptomatic after a phrenic nerve palsy following surgery for a cervical spinal stenosis, made us change our approach. This 67-yearold male was found to have a hepatodiaphragmatic interposition of the large intestine, i.e. Chilaiditi’s sign, as well (Figure 1).

Technique

Discussion

Conclusions