PURPOSE: We present a personal procedure of phrenoplasty-phrenoplication for the treatment of diaphragmatic relaxations and eventrations.
METHODS: The procedure uses a thoracic approach and consists in an anterior wide phrenotomy (which allows to solve concomitant abdominal lesions), followed by creation of two diaphragmatic tents in sagital plane which are sutured both between them and to the diaphragm. The final result is a reconstruction in 5 layers at the site of maximum mechanical load. We used the procedure in 6 patients with symptomatic diaphragmatic eventrations (one case associated with gastric volvulus).
RESULTS: We had no intraoperative accidents and no postoperative mortality or morbidity. The average operative time was 140 minutes. The mean hospitalisation period was 11 days. There was a significant improvement of postoperative respiratory test in all patients: VC increased with an average of 25% (12-38%) and FEV1 increased with an average of 19% (15-28%). With the exception of one patient with diaphragmatic relaxation secondary to a phrenic nerve invasion by a lung cancer who died after 2 years, all patients are alive at intervals between 6 and 16 years, with no respiratory complaints and no recurrence.
CONCLUSION: The procedure has certain advantages: simplicity and rapidity, avoidance of abdominal viscera injuries; creation and cross suture of the 2 tents allows a solid reconstruction of the diaphragm without synthetic material.
CLINICAL IMPLICATIONS: The procedure described by us may improve the management of patients with diaphragmatic relaxations and eventrations.
DISCLOSURE: Alexandru Botianu, None.