Long-term effect of bilateral plication of the diaphragm

Chest. 2000 Mar;117(3):786-9. doi: 10.1378/chest.117.3.786.


Study objectives: To assess the feasibility and clinical outcome of bilateral plication of the diaphragm in patients with bilateral diaphragmatic paralysis (BDP) caused by neuralgic amyotrophy (NA), a mononeuritis of the phrenic nerves.

Design: Prospective, case-control study over a 1-year period.

Setting: A university hospital in The Netherlands.

Patients: Six patients who presented with BDP caused by NA.

Methods: The diagnosis of BDP was based on the absence of muscle response after cervical magnetic stimulation of both phrenic nerves. Three patients did not undergo surgery but were observed for a period of 2 years, and the other three patients underwent a limited lateral thoracotomy at the eighth intercostal space. Plication was performed by U-stitches until the diaphragm was as tight as possible. Vital capacity (VC) and arterial blood gas was measured during follow-up.

Results: One month postoperatively, mean VC measured in the supine position was significantly improved by 17%, and this effect was sustained for 12 months. Arterial PO(2) increased by 45%. VC and blood gas levels did not improve in the three patients that were only observed during the 2-year period. All three surgical patients could sleep in the supine position after the operation.

Conclusion: Bilateral plication of the diaphragm for NA-induced paralysis results in improvement of ventilation and blood gas exchange, allowing patients to sleep in the supine position without dyspnea.

MeSH terms

  • Aged
  • Brachial Plexus Neuritis / surgery*
  • Carbon Dioxide / blood
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Oxygen / blood
  • Phrenic Nerve*
  • Postoperative Complications / etiology*
  • Postoperative Complications / physiopathology
  • Prospective Studies
  • Pulmonary Gas Exchange / physiology
  • Respiratory Paralysis / surgery*
  • Suture Techniques*
  • Vital Capacity / physiology


  • Carbon Dioxide
  • Oxygen