Prosthetic Reconstruction of the Resected Diaphragm: The Way To Go

Abstract

We read with much interest the article by Menezes andcolleagues in CHEST (May 2000),1Menezes SLS Chagas PSC Macedo-Neto AV et al.Suture or prosthetic reconstruction of experimental diaphragmatic defects: respiratory repercussions.Chest. 2000; 117: 1443-1448Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar regarding thefunctional outcome of primary as opposed to prosthetic(polytetrafluoroethylene) reconstruction of the diaphragm. Theirconclusion is that, “ … at least from a mechanical standpoint …,” prosthetic reconstruction is to be preferred to the primaryclosure of large diaphragmatic defects. In our recent, retrospective, bi-institutional review2Rocco G Rendina EA Meroni A et al.Prognostic factors after surgical treatment of lung cancer invading the diaphragm.Ann Thorac Surg. 1999; 68: 2065-2068Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar of 15 patients having undergoneresection of the diaphragm involved by primary lung cancer, we haveproved that extended resections along with the prosthetic replacementof the resected diaphragm may portend a better long-term prognosis. We, as thoracic surgeons, have wondered what the functional outcome of aprosthetic reconstruction of the diaphragm could possibly be. Menezesand coworkers1Menezes SLS Chagas PSC Macedo-Neto AV et al.Suture or prosthetic reconstruction of experimental diaphragmatic defects: respiratory repercussions.Chest. 2000; 117: 1443-1448Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar should be commended on providing us withthe answer. Both under an oncologic and functional point of view, prosthetic (polytetrafluoroethylene) reconstruction of the diaphragm isthe method of choice when large diaphragmatic defects need to berepaired.