Download PDF
Thorac Cardiovasc Surg 2023; 71(06): 483-489
DOI: 10.1055/s-0041-1735496
Original Thoracic

Results of the Diaphragmatic Plication Database: 10 Years' Experience

Nils Jurriaan Kosse 
1   Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
2   Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
,
Thomas Galetin
1   Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
2   Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
,
Sarah Bettina Schwarz
3   Department of Pneumology, University Witten Herdecke Faculty of Health, Witten, Germany
4   Lungclinic Merheim/Pneumology, Kliniken der Stadt Köln gGmbH, Koeln, Germany
,
Tim Mathes
5   Institut für Forschung in der operativen Medizin (IFOM), Universität Witten/Herdecke Fakultät für Gesundheit, Witten, Nordrhein-Westfalen, Germany
,
Aris Koryllos
1   Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
2   Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
,
Alberto Lopez-Pastorini
1   Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
2   Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
,
Frank Beckers
6   Department of Thoracic Surgery, St Vinzenz Hospital, Koeln, Germany
,
Erich Stoelben
1   Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
2   Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Background Unilateral diaphragmatic paralysis or paresis (UDP) in adults is an often overlooked disease which relevantly impairs the patient's lung function and quality of life. Particularly in idiopathic UDP, there is no evidence for conservative therapy and only little evidence for surgical therapy.

Methods The method involves retrospective single-center analysis of patients with UDP persistent for at least 1 year who were operated by diaphragmatic resection, plication, and augmentation with a polypropylene mesh. The patients were tested for lung and diaphragmatic function, six-minute walk test (6MWT), and blood gas analysis before, 3 and 12 months after surgery.

Results In total, 85 patients received surgery for UDP. The most frequent reasons for UDP were idiopathic (67%), iatrogenic (mainly cardiac and cervical spine surgery; 24%), and trauma (9%). The mean operation time was 84 ± 24 minutes, the length of hospital stay 8.4 ± 3.9 days, chest tubes were removed after 11.7 ± 4.1 days. Overall morbidity was 42%, mortality 0%. Forced expiratory volume in one second (FEV1) in supine position improved by 12.4% absolute, vital capacity by 11.8% absolute, and sniff nasal inspiratory pressure by 1.4 kPa 12 months after surgery (p <0.001 each). Total lung capacity increased by 6.8% absolute at 12 months (p = 0.001) The 6MWT distance improved by 45.9 m at 3 months and 50.9 m at 12 months (p = 0.001, each).

Conclusion Surgical therapy for UDP is highly effective in the long term. The superiority over conservative treatments needs to be evaluated prospectively with standardized physiotherapeutic protocols. FEV1 in supine position and 6MWT are easy to perform tests and represent statistically and patient-relevant outcomes.

Keywords

diaphragm - surgery - disease - quality of life - ventilation

Supplementary Material



Publication History

Received: 16 November 2020

Accepted: 07 June 2021

Article published online:
15 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Windisch W, Schönhofer B, Magnet FS, Stoelben E, Kabitz H-J. Diagnosis and treatment of diaphragmatic dysfunction. Pneumologie 2016; 70 (07) 454-461
    PubMedGoogle Scholar
  • 2 Riley EA. Idiopathic diaphragmatic paralysis; a report of eight cases. Am J Med 1962; 32: 404-416
    CrossrefPubMedGoogle Scholar
  • 3 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 (05) 1853-1857 , discussion 1857
    CrossrefPubMedGoogle Scholar
  • 4 Graham DR, Kaplan D, Evans CC, Hind CR, Donnelly RJ. Diaphragmatic plication for unilateral diaphragmatic paralysis: a 10-year experience. Ann Thorac Surg 1990; 49 (02) 248-251 , discussion 252
    CrossrefPubMedGoogle Scholar
  • 5 Ashkir ZM, Tsaknis G. A rash and a rare cause of unilateral diaphragmatic paralysis. BMJ Case Rep 2017; 2017: bcr2016218440
    CrossrefPubMedGoogle Scholar
  • 6 Elefteriades J, Singh M, Tang P. et al. Unilateral diaphragm paralysis: etiology, impact, and natural history. J Cardiovasc Surg (Torino) 2008; 49 (02) 289-295
    PubMedGoogle Scholar
  • 7 Higgs SM, Hussain A, Jackson M, Donnelly RJ, Berrisford RG. Long term results of diaphragmatic plication for unilateral diaphragm paralysis. Eur J Cardiothorac Surg 2002; 21 (02) 294-297
    CrossrefPubMedGoogle Scholar
  • 8 Qureshi A. Diaphragm paralysis. Semin Respir Crit Care Med 2009; 30 (03) 315-320
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I. Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis. J Cardiothorac Surg 2010; 5: 111
    CrossrefPubMedGoogle Scholar
  • 10 Ridyard JB, Stewart RM. Regional lung function in unilateral diaphragmatic paralysis. Thorax 1976; 31 (04) 438-442
    CrossrefPubMedGoogle Scholar
  • 11 Han KY, Bang HJ. Exercise therapy for a patient with persistent dyspnea after combined traumatic diaphragmatic rupture and phrenic nerve injury. PM R 2015; 7 (02) 214-217
    CrossrefPubMedGoogle Scholar
  • 12 Kotwicki T, Jozwiak M. Conservative management of neuromuscular scoliosis: personal experience and review of literature. Disabil Rehabil 2008; 30 (10) 792-798
    CrossrefPubMedGoogle Scholar
  • 13 Versteegh MIM, Braun J, Voigt PG. et al. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg 2007; 32 (03) 449-456
    CrossrefPubMedGoogle Scholar
  • 14 Groth SS, Rueth NM, Kast T. et al. Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: an objective evaluation of short-term and midterm results. J Thorac Cardiovasc Surg 2010; 139 (06) 1452-1456
    CrossrefPubMedGoogle Scholar
  • 15 Ricoy J, Rodríguez-Núñez N, Álvarez-Dobaño JM, Toubes ME, Riveiro V, Valdés L. Diaphragmatic dysfunction. Pulmonology 2019; 25 (04) 223-235
    CrossrefPubMedGoogle Scholar
  • 16 Krieger LM, Krieger AJ. The intercostal to phrenic nerve transfer: an effective means of reanimating the diaphragm in patients with high cervical spine injury. Plast Reconstr Surg 2000; 105 (04) 1255-1261
    PubMedGoogle Scholar
  • 17 Kaufman MR, Elkwood AI, Rose MI. et al. Reinnervation of the paralyzed diaphragm: application of nerve surgery techniques following unilateral phrenic nerve injury. Chest 2011; 140 (01) 191-197
    CrossrefPubMedGoogle Scholar
  • 18 Kawashima S, Kohno T, Fujimori S. et al. Phrenic nerve reconstruction in complete video-assisted thoracic surgery. Interact Cardiovasc Thorac Surg 2015; 20 (01) 54-59
    CrossrefPubMedGoogle Scholar
  • 19 World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310 (20) 2191-2194
    CrossrefPubMedGoogle Scholar
  • 20 Meyer FJ, Borst MM, Buschmann H-C. et al. Exercise testing in respiratory medicine—DGP recommendations. Pneumologie 2018; 72 (10) 687-731
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Defosse J, Schieren M, Loop T. et al. The German Thorax Registry: implementation of an established tool of perioperative health care research. Zentralbl Chir 2017; 142 (03) 330-336
    PubMedGoogle Scholar
  • 22 R Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2019
    Google Scholar
  • 23 Seely AJE, Ivanovic J, Threader J. et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 2010; 90 (03) 936-942 , discussion 942
    CrossrefPubMedGoogle Scholar
  • 24 Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract 2017; 23 (02) 377-381
    CrossrefPubMedGoogle Scholar
  • 25 Caleffi-Pereira M, Pletsch-Assunção R, Cardenas LZ. et al. Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm. BMC Pulm Med 2018; 18 (01) 126
    CrossrefPubMedGoogle Scholar
  • 26 Steier J, Lunt A, Hart N, Polkey MI, Moxham J. Observational study of the effect of obesity on lung volumes. Thorax 2014; 69 (08) 752-759
    CrossrefPubMedGoogle Scholar
  • 27 Bin Asaf B, Kodaganur Gopinath S, Kumar A, Puri HV, Pulle MV, Bishnoi S. Robotic diaphragmatic plication for eventration: a retrospective analysis of efficacy, safety, and feasibility. Asian J Endosc Surg 2021; 14 (01) 70-76
    CrossrefPubMedGoogle Scholar
  • 28 Taberham RJ, Raza A, Alzetani A. et al. VATS plication of the diaphragm: a descriptive observational 10-year Southampton experience. Innovations (Phila) 2017; 12 (06) 398-405
    CrossrefPubMedGoogle Scholar
  • 29 Gaissert HA, Trulock EP, Cooper JD, Sundaresan RS, Patterson GA. Comparison of early functional results after volume reduction or lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 1996; 111 (02) 296-306 , discussion 306–307
    CrossrefPubMedGoogle Scholar
  • 30 Kosse NJ, Windisch W, Koryllos A. et al. Development of the Diaphragmatic Paralysis Questionnaire: a simple tool for patient relevant outcome. Interact Cardiovasc Thorac Surg 2021; 32 (02) 244-249
    CrossrefPubMedGoogle Scholar
  • 31 Kaufman MR, Elkwood AI, Brown D. et al. Long-term follow-up after phrenic nerve reconstruction for diaphragmatic paralysis: a review of 180 patients. J Reconstr Microsurg 2017; 33 (01) 63-69
    PubMedGoogle Scholar
  • 32 Kaufman MR, Bauer T, Onders RP. et al. Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers. Interact Cardiovasc Thorac Surg 2021; 32 (05) 753-760
    CrossrefPubMedGoogle Scholar
  • 33 Kaufman MR, Elkwood AI, Colicchio AR. et al. Functional restoration of diaphragmatic paralysis: an evaluation of phrenic nerve reconstruction. Ann Thorac Surg 2014; 97 (01) 260-266
    CrossrefPubMedGoogle Scholar