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Diaphragmmatic eventration: long-term follow-up and results of open-chest plicature

Cardiothoracic Surgery, University Hospital, 3000-075 Coimbra, Portugal

Received 23 October 2008; received in revised form 11 May 2009; accepted 19 May 2009.

^_* Corresponding author. Tel.: +351 239400418; fax: +351 239829674. (Email: antunes.cct.huc{at}sapo.pt).

Objective: Diaphragmmatic eventration is a relatively uncommon entity with a simple surgical correction technique – plication of the diaphragm. This study aims to assess the clinical and ventilatory impact of this technique. Materials: From April 1988 to February 2007, we operated on 20 patients (12 men) with diaphragmmatic eventration using the postero-lateral approach and correction by radial plication. The mean age of the patients studied was 56.3 ± 15.6 years (range: 13–74 years). A traumatic cause was identified in 13 patients; one patient had a congenital cause and the remainder were of idiopathic origin. Chronic obstructive pulmonary disease and arterial hypertension were present in one-half of the study group, while diabetes mellitus was present in three patients. Dyspnoea was the most common complaint in 75% of the patients, and thoracic pain was present in 25%. The mean forced expiratory volume in 1 s (FEV₁) and vital capacity (VC) were 66.2 ± 15.3% and 70.4 ± 16% of the predicted values, respectively. Results: There was no operative mortality. Apart from a patient with moderate/severe pain and another who had pneumonia, there were no other important perioperative complications. Average drainage time was 3.3 ± 1.6 days (range: 2–7 days). Hospitalisation time was 6.2 ± 1.6 days (5–10 days). Follow-up was complete, for a mean of 59.6 ± 55.1 months (4–206 months). There were three late deaths (one sudden, one stroke and one trauma). Eight of the 17 survivors (47%) are asymptomatic. According to the MRC/ATS grading system, the dyspnoea score was 2.06 ± 0.97 preoperatively and 1.06 ± 1.14 postoperatively (p = 0.007). At follow-up, the FEV₁ was 76.1 ± 20.1% and the VC was 78.4 ± 17.3% (p > 0.1). Two patients had chronic pain. Conclusion: Plication of the diaphragm is a safe and efficient procedure. Most patients experienced significant clinical improvement with enhancement of the FEV₁ and VC. Chronic surgical pain still remains a potential problem with the classical approach.

Key Words: Diaphragm • Eventration • Hernia • Plicature • Surgery