Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: An objective evaluation of short-term and midterm results

Groth, Shawn S.; Rueth, Natasha M.; Kast, Teri; D'Cunha, Jonathan; Kelly, Rosemary F.; Maddaus, Michael A.; Andrade, Rafael S.

doi:10.1016/j.jtcvs.2009.10.020

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1452-1456, June 2010

Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: An objective evaluation of short-term and midterm results

Shawn S. Groth, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Natasha M. Rueth, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Teri Kast, RN
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Jonathan D'Cunha, MD, PhD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Rosemary F. Kelly, MD
- Department of Surgery, Division of Cardiothoracic Surgery, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minn
Michael A. Maddaus, MD, FACS
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Rafael S. Andrade, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
- Address for reprints: Rafael S. Andrade, MD, Division of Thoracic and Foregut Surgery, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455.

Received 6 May 2009; received in revised form 29 August 2009; accepted 7 October 2009. published online 18 January 2010.

Objectives

We sought to objectively assess our outcomes after laparoscopic diaphragmatic plication for symptomatic hemidiaphragmatic paralysis or eventration using a respiratory quality-of-life questionnaire and pulmonary function tests.

Methods

We performed a retrospective review of all symptomatic patients with hemidiaphragmatic paralysis or eventration who underwent laparoscopic diaphragmatic plication from March 1, 2005, through August 31, 2008. Patients with primary neuromuscular disorders were excluded from our analysis. We collected St George's Respiratory Questionnaire scores (a respiratory quality-of-life questionnaire) and pulmonary function test results preoperatively and at 1 month and 1 year postoperatively. A 2-sided significance level of .05 was used for all statistical testing.

Results

During the study period, 25 patients underwent laparoscopic diaphragmatic plication (9 right-sided and 16 left-sided plications); 1 patient required conversion to a thoracotomy. St George's Respiratory Questionnaire total scores (59.3 ± 26.8) improved by more than 20 points on average (a reduction of ≥4 points after an intervention is considered a clinically significant improvement). This improvement was statistically significant at 1 month (36.6 ± 15.9, P = .001) and maintained significance at 1 year (30.8 ± 18.8, P = .009). Similarly, percent predicted maximum forced inspiratory flow (93.2% ± 34.1%) was significantly improved 1 month after plication (113.9% ± 31.8%, P = .01) and maintained significance at 1 year (111.5% ± 30.9%, P = .02).

Conclusions

Our objective evaluation of laparoscopic diaphragmatic plication for hemidiaphragmatic paralysis or eventration demonstrated significant short-term and midterm improvements in respiratory quality of life and pulmonary function test results. This approach represents a potential paradigm shift in the surgical management of hemidiaphragmatic paralysis or eventration.

CTSNet classification: 6;28

Abbreviations and Acronyms: FEV₁%, percent predicted forced expiratory volume in 1 second, FIFmax%, percent predicted maximum forced inspiratory flow, FVC%, percent predicted forced vital capacity, PFT, pulmonary function test, SGRQ, St George's Respiratory Questionnaire