Long term results of diaphragmatic plication for unilateral diaphragm paralysis

• Published in: European journal of cardio-thoracic surgery 2002-02, Vol.21 (2), p.294-297
• Main Authors: Higgs, Simon M., Hussain, Afzal, Jackson, Mark, Donnelly, Raymund J., Berrisford, Richard G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Diaphragm - surgery; Diaphragmatic paralysis; Diaphragmatic plication; Female; Follow-Up Studies; Humans; Long term follow-up; Male; Middle Aged; Postoperative Care - methods; Recovery of Function; Respiratory Function Tests; Respiratory Paralysis - diagnosis; Respiratory Paralysis - surgery; Retrospective Studies; Severity of Illness Index; Thoracic surgery; Thoracotomy - methods; Time Factors; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(01)01107-1

Objectives: To examine whether diaphragmatic plication is an effective and lasting treatment option for non-malignant diaphragmatic paralysis. Methods: Nineteen patients who had undergone diaphragm plication (1983–1990) were recalled for interview, pulmonary function testing and chest X-ray. Results: There were 13 men and six women aged 24–73 (mean 55). Diaphragm paralysis was idiopathic (n=9), postsurgical (n=3), related to cervical spondylosis (n=4) and neck injury (n=2). Patients presented with breathlessness (18/19) or orthopnoea (1/19). Symptoms had lasted 3–60 months (mean 24 months). All patients had a raised hemidiaphragm on chest X-ray with paradoxical movement on ultrasound. Mean preoperative FVC was 71% predicted (range 38–93, SD 12.9) and mean FEV1 was 67% predicted (range 33–90, SD 10.8). Supine lung volumes were 81% (mean) of sitting values. There were six right plications and 13 left. There were no postoperative deaths. One patient required re-plication. Follow-up (18/19 of original operated patients) ranged from 7–14 years (mean 10 years). Three patients had died of unrelated causes and one patient failed to attend long term follow-up, leaving 15 patients of the original 19 operated on. Positional change in lung volumes was not affected by surgery at early (6 week) or late (≫5 year) follow-up. FVC, FEV1, FRC and TLC improved by 10.1*, 11.8*, 16.9* and 9.2*%, respectively, at early follow-up and 11.8*, 15.4*, 26 and 13.3*% at late follow-up (*P≪0.005 signed rank). Dyspnoea scores at long term follow-up improved 1 point (n=5), 2 points (n=5) and 3 points (n=2), remained unchanged (n=1) or dropped 1 point (n=2). Of the 15 patients followed up all but one who had been employed returned to work. 14/15 patients expressed satisfaction with their surgery. Conclusion: Diaphragm plication is an effective procedure with lasting results.