Dattaguru R Kulkarni, MS, Ajay H Bhandarwar, MS, Priyank D Kothari, Saurabh S Gandhi, MS, Chintan B Patel, MS, Amol N Wagh, MS, Eham L Arora. Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
Introduction: Diaphragmatic Eventration is an uncommon entity denoting abnormal elevation of hemidiaphragm. The condition is often asymptomatic, often discovered incidentally on radiological scans. Affected individuals suffer from chest discomfort, respiratory compromise & recurrent respiratory infections. The condition is most often congenital with irregular muscularization of diaphragmatic segments, or may be acquired secondary to phrenic nerve dysfunction.
Treatment of the condition was traditionally performed with an open thoracotomy with diaphragmatic plication. Attempts at diminishing morbidity of an open thoracotomy resulted in formulation of video assisted plication, & even a laparoscopic approach where excess diaphragm was excised with an endostapler. Thoracoscopic plication offers individualization of degree of plication as per severity of individual's condition.
Methods: At our centre, we adopted a thoracoscopic plication in 2 cases & endostapler resection of afflicted hemidiaphragm segment in 2 cases. In view of 1 patient developing a recurrence in both groups, we modified the procedure to add plication of diaphragm over the stapler line. This hybrid approach was utilized in 5 cases.
In all our cases, the diaphragmatic adhesions with the lung were dissected with energy source. Excess diaphragm was pinched off the abdominal organs & excised with endostapler extending from posterolateral to anteromedial aspects, staying away from pericardium. The staple line was reinforced with a layer of non-absorbable sutures. We then proceeded to plicate the hemidiaphragm along the length of staple line, with amount plicated decided on basis of laxity of segment being sutured
Conclusion: By strictly adhering to thoracoscopic access, we significantly reduced operative time, hospital stay, morbidity & recovery time for our cases. The hybrid procedure was found to be technically feasible, combining the advantages of endostapler excision with strengthening provided by plication and was associated with 0% recurrence on 6 months follow up with 50% recurrence in only stapler group.
Figure 1. Pre & Post-operative CT reconstructions of a patient who underwent hybrid repair of diaphragmatic eventration
Table 1. Case series of cases who underwent eventration repair thoracoscopically. Notably, no patient treated by hybrid technique sufffered from a recurrence
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79993
Program Number: P589
Presentation Session: Poster (Non CME)
Presentation Type: Poster
