Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study

Ann Thorac Surg. 2005 Jan;79(1):308-12. doi: 10.1016/j.athoracsur.2004.06.050.

Abstract

Background: This study seeks to evaluate results regarding the repair of diaphragmatic eventration using video-assisted thoracic surgery (VATS).

Methods: We performed a prospective observational study including patients referred to us for surgical treatment of diaphragmatic eventration during a 12-year period. Clinical, radiologic, and functional data were prospectively recorded. VATS was performed with two thoracoports and a 4-cm mini-thoracotomy. Diaphragmatic plication was performed using two nonresorbable running sutures from periphery to the cardio-phrenic angle. Follow-up data (clinical examination, chest roentgenogram, lung function tests at 3, 6, 12 months, and annually thereafter) were also prospectively recorded.

Results: Twelve patients (4 male adults, mean age 57.7 +/- 14.8 years) were operated on between 1992 and 2003. The left side was involved in 8 patients and the mean height of diaphragm elevation was 7.5 +/- 1.8 cm. All patients experienced symptoms related to the disease; in 2 patients the operation was carried out to achieve weaning from mechanical ventilation. The etiologic mechanism could be identified in 11 out of 12 patients (trauma, n = 9; Charcot-Marie disease, n = 1; calcified para-aortic nodes, n = 1). Mean operative time, drainage output, and hospital stay were 77 +/- 15 minutes, 0.8 +/- 04 L, and 3.4 +/- 0.7 days, respectively. No mortality was observed; 1 patient experienced postoperative pneumonia, which was treated using antibiotics. All patients experienced amelioration of symptoms and long-term lung function tests revealed a marked improvement of both the forced volume capacity and the forced expiratory volume at 1 second. No relapses were observed at follow-up chest roentgenogram.

Conclusions: Treatment using VATS is a safe and effective alternative to conventional surgery. Functional improvement persists at long-term follow-up.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Calcinosis / complications
  • Charcot-Marie-Tooth Disease / complications
  • Diaphragmatic Eventration / etiology
  • Diaphragmatic Eventration / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Para-Aortic Bodies / pathology
  • Phrenic Nerve / injuries
  • Postoperative Complications / surgery
  • Prospective Studies
  • Spirometry
  • Suture Techniques
  • Thoracic Surgery, Video-Assisted*
  • Thoracotomy / methods
  • Treatment Outcome
  • Wounds, Nonpenetrating / complications