Vats Plication Of Diaphragm: The Southampton Experience
Southampton General Hospital, Southampton, United Kingdom.
OBJECTIVE: we set out to report our experience with diaphragmatic plication between 2008 - 2016
METHODS: Careful adult patients selected on aetiology and combination of investigations including plain chest x-ray, CT scan, Lung functions in supine and sitting positions, radiological / ultrasonic screening for diaphragmatic movement and Phrenic nerve conduction studies. Triportal VATS plication, using CO2 insufflation to maximum 12mmHg. High risk patients and bilateral repairs were electively admitted to Intensive Care postoperatively
RESULTS: 35 patients had their diaphragm plicated, 24 males. Mean age 56.6 years (range 23-76). The mean BMI was 32.1 (range 22.2- 45.4). 21 were right, 13 left, 2 patients had simultaneous bilateral plication and 1 had sequential plication. paralysis was idiopathic in 17, post-traumatic 5, post removal of mediastinal tumour 4. All patients presented with orthopnoea and dyspnoea, 3 were on nocturnal Non-Invasive Ventilation. 5 were diabetic and 16 were smokers. Mean supine FEV1 62.5% of predicted. 22 were performed by VATS (63%) 3 converted, 13 were open limited thoracotomy (historic). Mean hospital stay 4.5 days (range 1-18, mode 2 days). ITU admission was required in 6 patients for mechanical ventilation 0-3 days. 3 patients (8.5%) had no improvement in symptoms
CONCLUSIONS: VATS diaphragmatic plication is feasible and safe and should be considered first choice. It is also safe to perform bilateral VATS repair in the same sitting. VATS plication is associated with low morbidity and has been shown to produce life-changing improvements. A careful balance between benefits, risks and expectations is required before referral for such procedures
Back to 2017 Thoracic Track Overview