PURPOSE: Diaphragm paralysis in the adult is frequently seen and in many patients causes significant dyspnea on exertion and inability to participate in normal activities. Despite reports describing diaphragm plication, there remains controversy regarding its effects and whether the risks of surgery outweigh the benefits in these patients. We therefore examined our results with diaphragm plication in adults at the Medical College of Wisconsin.
METHODS: Diaphragm plications done at the Medical College of Wisconsin were reviewed. Surgical morbidity and mortality was tabulated. Patients underwent pulmonary function testing (PFT) and completed UCSD Shortness of Breath Questionnaires (SOBQ) before and 8 weeks following the procedure. Preoperative and postoperative PFTs and SOBQ were used to measure objective and subjective improvement respectively.
RESULTS: Between 2002 and 2011 there were 35 diaphragm plications performed. Average age was 56 (36-80). All patients were symptomatic and causes included postsurgical (14), idiopathic (12), trauma (7), and cancer (2). Methods of plication included thoracotomy and laparoscopic/robotic-assisted. There were no mortalities. Complications occurred in 6 patients (17%) consisting of atrial fibrillation (5), reintubation (2), and urinary retention (2). Average length of stay was 6 days. Pre- and Postoperative PFTs and SOBQ were available in 26 patients and all of them showed significant improvement. Mean Forced Vital Capacity, Forced Expiratory Volume in 1 Second, Residual Volume and Total Lung Capacity all improved by an average of 20%, 21%, 17%, and 11% respectively. SOBQ scores decreased by an average of 33 (a reduction of 5 is considered a clinically significant improvement).
CONCLUSIONS: Diaphragm plication can be done safely in adult patients with diaphragm paralysis and leads to measurable improvement objectively and subjectively as measured by PFTs and SOBQ.
CLINICAL IMPLICATIONS: In adult patients with symptomatic diaphragm paralysis, surgical diaphragm plication is beneficial and should become part of the standard treatment algorithm.
DISCLOSURE: The following authors have nothing to disclose: Mario Gasparri, Trisha Wilcox, William Tisol, George Haasler
No Product/Research Disclosure Information