Abstract
Background
Diaphragmatic plication is an approved surgical procedure for treatment of symptomatic diaphragmatic paralysis and eventration. We aim to define our minimally invasive technique of plication and objectively assess our surgical outcomes of the largest series reported in the literature so far, using pulmonary function tests.
Methods
Symptomatic patients whom were planned to undergo plication using video-assisted mini-thoracotomy between December 2009 and December 2015 were the cohort of this retrospective study. Single camera port and a utility incision (3–4 cm) were used for access. Data of patient demographics with preoperative and postoperative spirometric results were collected for statistical comparison.
Results
Procedure (30 left, 7 right) was completed in 37 (27 male, 10 female) patients. One patient was excluded because of insufficient objective postoperative comparison criteria due to previous permanent tracheostomy. Mean length of surgery was 48.8 ± 19.7 (range: 30–70) min. Postoperative overall morbidity was 8.3 %, with no mortality. The mean length of hospital stay was 3.1 ± 1.7 days. All patients except one (97.3 %) were asymptomatic on discharge and on follow-ups. Significant improvement in measurements of forced expiratory volume in 1st second was observed on postoperative measurements (P < 0.001), with a mean overall increase of 13 % in whole cohort. No recurrence was detected throughout a mean follow-up of 19 months.
Conclusions
Diaphragmatic plication via video-assisted mini-thoracotomy is an effective and curative surgical procedure which can be performed successfully with low morbidity rates. As it combines the rapidity and economical benefits of open thoracotomy with the advantages of video thoracoscopic procedures such as fast recovery and short postoperative hospital stay, it can be preferred as a safe and effective alternative hybrid method compared to standard open or closed techniques, for symptomatic patients with non-functional hemidiaphragm.
Similar content being viewed by others
References
Kerstine KH, Limmer KK, Grannis FW Jr, Tiep BL (2011) Surgical plication of diaphragm for paralysis and eventration. In: Sugarbaker DJ (ed) Adult chest surgery. The McGraw-Hill Companies Inc, New York, pp 1077–1082
Gharagozloo F, McReynolds SD, Snyder L (1995) Thoracoscopic plication of the diaphragm. Surg Endosc 9:1204–1206
Shields TW (2005) Diaphragmatic function, diaphragmatic paralysis, and eventration of the diaphragm. In: Shields TW, LoCicero J III, Ponn RB, Rusch VW (eds) General thoracic surgery, 6th edn. Williams and Wilkins, Philadelphia, pp 740–745
Groth SS, Andrade RS (2010) Diaphragm plication for eventration or paralysis: a review of the literature. Ann Thorac Surg 89:2146–2150
Hines MH (2003) Video-assisted diaphragm plication in children. Ann Thorac Surg 76:234–236
Rombola C, Crespo MG, Lopez PT, Martinez AH, Atance PL, Ramirez AT, Montes JA (2014) Video-assisted minithoracotomy diaphragmatic plication: respiratory effects in adults. Thorac Cardiovasc Surg. doi:10.1055/s-0034-1383812
Kim DH, Hwang JJ, Kim KD (2007) Thoracoscopic diaphragmatic plication using three 5 mm ports. Interact Cardiovasc Thorac Surg 6:280–281
Mouroux J, Venissac N, Leo F, Alifano M, Guillot F (2005) Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study. Ann Thorac Surg 79:308–312
Groth SS, Rueth NM, Kast T, D’Cunha J, Kelly RF, Maddaus MA, Andrade RS (2010) Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: an objective evaluation of short-term and midterm results. J Thorac Cardiovasc Surg 139:1452–1456
Visouli AN, Mpakas A, Zarogoulidis P, Machairiotis N, Stylianaki A, Katsikogiannis N et al (2012) Video assisted thoracoscopic plication of the left hemidiaphragm in symptomatic eventration in adulthood. J Thorac Dis 4(S1):6–16
Freeman RK, Wozniak TC, Fitzgerald EB (2006) Functional and physiologic results of video-assisted thoracoscopic diaphragm in adult patient with unilateral diaphragm paralysis. Ann Thorac Surg 81:1853–1857
Gonzales-Zamora JF, Perez-Guille B, Soriano-Rosales RE, Jimenez-Bravo-Luna MA, Guiterrez-Castrellon P, Ridaura-Sanz C, Alvarez FV (2005) Video-assisted thoracoscopy for diaphragmatic plication: experimental study in a canine model. J Laparoendosc Adv Surg Tech A 15:661–666
Mouroux J, Padovani B, Poirier NC, Benchimol D, Bourgeon A, Deslauriers J, Richelme H (1996) Technique for the repair of diaphragmatic eventration. Ann Thorac Surg 62:905–907
Hwang Z, Shin JS, Cho YH, Sun K, Lee IS (2003) A simple technique for the thoracoscopic plication of the diaphragm. Chest 124:376–378
Balci AE, Ozyurtkan MO (2010) Clinical and surgical specification af adult unilateral diaphragmatic eventration according to their aetiology in 28 patients. Importance of using diaphragmatic patch and minimal thoracotomy incisions. Eur J Cardiothorac Surg 37:606–612
Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I (2010) Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis. J Cardiothorac Surg 5:111
Takeda S, Nakahara K, Fujii Y, Matsumura A, Minami M, Matsuda H (1995) Effects of diaphragmatic plication on respiratory mechanics in dogs with unilateral and bilateral phrenic nerve paralysis. Chest 107:798–804
Dunning J (2015) Thoracoscopic diaphragm plication. Interact Cardiovasc Thorac Surg 20:689–690
Freeman RK, Woerkom JV, Vyuerberg A, Ascioti AJ (2009) Long-term follow-up of the functional and physiologic results of diaphragm plication in adult with unilateral diaphragm paralysis. Ann Thorac Surg 88:1112–1117
Gazala S, Hunt I, Bédard ELR (2012) Diaphragmatic plication offers functional improvement in dispnoea and better pulmonary function with low morbidity. Interact CardioVasc Thorac Surg 15:505–508
Welvaart WN, Jak PMC, van de Veerdonk MC, Marcus JT, Ottenheijm CAC, Paul MA, Vonk Noordegraaf A (2013) Effects of diaphragm plication on pulmonary function and cardiopulmonary exercise parameters. Eur J Cardiothorac Surg 44:643–647
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Irfan Yalcinkaya, Serdar Evman, Tunc Lacin, Levent Alpay, Mustafa Kupeli, and Ilhan Ocakcioglu have no conflict of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Yalcinkaya, I., Evman, S., Lacin, T. et al. Video-assisted minimally invasive diaphragmatic plication: feasibility of a recognized procedure through an uncharacteristic hybrid approach. Surg Endosc 31, 1772–1777 (2017). https://doi.org/10.1007/s00464-016-5171-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-5171-8