Video-Assisted Minithoracotomy Diaphragmatic Plication: Respiratory Effects in Adults

Abstract

Objectives The objective of this study was to analyze the clinical respiratory and spirometric effects of video-assisted minithoracotomy diaphragmatic plication (VAM-T DP) in the treatment of diaphragmatic eventration.

Methods A retrospective longitudinal study of 18 patients who underwent a VAM-T DP in our service between February 2005 and July 2011 was performed. Data of patient characteristics, preoperative clinical variables, and postoperative results (3, 6, and 12 months) were collected for statistical analysis using the software package SPSS 13.0 for Windows (Wilcoxon test, Friedman test, and Z-test).

Results The main clinical respiratory and spirometric variables improved significantly and remained stable over 1 year.

Conclusions VAM-T DP is a viable and safe procedure that improves the spirometry values and offers stable results during the first year. To our knowledge, the present series is the second largest published report in English relating to this procedure in adults.

Keywords

diaphragmatic surgery - diaphragmatic plication - respiratory paralysis - diaphragmatic eventration

• References

• 1 León Atance P, Rombolá CA, Honguero Martínez AF. Parálisis y eventración diafragmática. In: Fernández FL, Freixinet GJ, , eds. Tratado de Cirugía Torácica. Madrid, Spain: SEPAR/EDIMSA; 2010: 1245-1252
• 2 King JE, Rajesh PB. Benign disease of the diaphragm. In: Fielding JWL, , ed. Upper Gastroinstestinal Surgery. London: Springer-Verlag; 2005: 117-126
• 3 Favre JP, Favoulet P, Cheynel N, Benoit L. Tratamiento quirúrgico de las eventraciones diafragmáticas. ECM. Técnicas quirúrgicas. Paris, France: Elsevier Masson SAS; 2005: 40-245
• 4 Christensen P. Eventration of the diaphragm. Thorax 1959; 14: 311-319
• 5 Favre JP, Hagry O, Cheynel N. Tratamiento quirúrgico de las hernias diafragmáticas raras. EMC. Técnicas quirúrgicas. Paris, France: Elsevier Masson SAS; 2003: 40-247
• 6 Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg 2006; 81 (5) 1853-1857 , discussion 1857
• 7 Shields TW, Diaphragmatic function, diaphragmatic paralysis and eventration of the diaphragm. In: Shields TW. , ed. General Thoracic Surgery. Malvern, PA: Williams and Wilkins; 1994: 607-612
• 8 Mouroux J, Venissac N, Leo F, Alifano M, Guillot F. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study. Ann Thorac Surg 2005; 79 (1) 308-312
• 9 Fitz-Henry J. The ASA classification and peri-operative risk. Ann R Coll Surg Engl 2011; 93 (3) 185-187
• 10 Longás VJ, Cuartero LJ. Escalas del paciente intervenido. In: Longás VJ, Cuartero LJ, , eds. Manual del anestesiólogo. Majadahonda (Madrid), Spain: Ergon; 2007: 245-248
• 11 Calvinho P, Bastos C, Bernardo JE, Eugénio L, Antunes MJ. Diaphragmmatic eventration: long-term follow-up and results of open-chest plicature. Eur J Cardiothorac Surg 2009; 36: 883-887
• 12 Mouroux J, Padovani B, Poirier NC , et al. Technique for the repair of diaphragmatic eventration. Ann Thorac Surg 1996; 62 (3) 905-907
• 13 Gazala S, Hunt I, Bédard EL. Diaphragmatic plication offers functional improvement in dyspnoea and better pulmonary function with low morbidity. Interact Cardiovasc Thorac Surg 2012; 15 (3) 505-508
• 14 Freeman RK, Van Woerkom J, Vyverberg A, Ascioti AJ. Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. Ann Thorac Surg 2009; 88 (4) 1112-1117
• 15 Phadnis J, Pilling JE, Evans TW, Goldstraw P. Abdominal compartment syndrome: a rare complication of plication of the diaphragm. Ann Thorac Surg 2006; 82 (1) 334-336
• 16 Deng Y, Byth K, Paterson HS. Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann Thorac Surg 2003; 76 (2) 459-463
• 17 Lai DT, Paterson HS. Mini-thoracotomy for diaphragmatic plication with thoracoscopic assistance. Ann Thorac Surg 1999; 68 (6) 2364-2365
• 18 Kim H, Joo Hwang J, Kim KD. Thoracoscopic diaphragmatic plication using three 5 mm ports. Interact Cardiovasc Thorac Surg 2007; 6 (3) 280-281