Is Thoracoscopic Diaphragmatic Plication In Pediastrics Diaphragmatic Eventration Bad: 5 Years Long-term Outcome?
Sungkwang Lee, Do Hyung Kim, Bong Soo Son, Joo Hyung Son.
Pusan National University Yangsan Hospital, Yangsan, Korea, Republic of.
BACKGROUND - Pleating technique which is performed several interupped suture on several folding diaphragm is widely used in plication of diaphragm eventration. However, thoracotomy was lead to musculoskeletal deformity in pediatrics. Pleating thechnique with thoracoscopy very challenge by complex procedure and limited space. To overcome this point, invaginating technique which is pushed the center of the diaphragm toword abdomen and is sutured both ends of the diaphragm fold is used for thoracoscopic plication. The purpose of study is to evaluate usefulness of the invaginating technique. METHODS - March 2007 to December 2017, 23 patients underwent diaphragm plication. The eventration level was calculated as a percentage using 100-(100B / A) in chest X-ray. Distance between the peaks of hemidiaphragm and the apex; A is normal and B is eventrated hemidiaphragm.
RESULTS - A total of 23 patients underwent diaphragm plication. Ten of them underwent pleating technique (P) with thoracotomy and 13 of them underwent invaginating technique (I) with thoracoscopy. Two of them was converted to thoracotomy. After cardiac or thoracic surgery, fifteen patient was occurred eventration (P vs I; 10 vs 5). The mean operation time was 114.1 ± 53.1 mins (P vs I; 145.5 ± 50.1, 90.0 ± 42.7, P=0.009). The mean preoperative eventration values was calculated as 25.9 ± 9.1% (P vs I; 25.0 ± 5.6%, 26.6 ± 11.3%), -2.6 ± 8.2% (P vs I; -4.4 ± 9.7%, -1.1 ± 6.9%) in the postoperative period. From 1st postoperative month to 5th year, the degree of diaphragm elevation was maintained well. CONCLUSIONS -Surgical treatment of diaphragmatic eventration is thought to help lung volume development and thoracoscopic plication is thought to help to musculosketal development in pediastics. In our study, the long-term results of invagintion technique with thoracoscopy were not inferior to pleating technique and this technique could be good option in pediatrics with diaphragmatic eventration. Legend - The percentage of eventration level between groups
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