Clinical and surgical specifications of adult unilateral diaphragmatic eventration according to their aetiology in 28 patients. Importance of using diaphragmatic patch and minimal thoracotomy incision.

OBJECTIVE

This study aims to determine the differences among various diaphragmatic eventration (DE) aetiologies and to compare the outcomes of the operation relative to the use of a diaphragmatic patch.

METHODS

Between 2003 and 2009, 28 patients with a DE who underwent surgery were classified according to the following aetiology: (a) previous operation or disease, (b) congenital/idiopathic and (c) trauma. Patients who received diaphragmatic patches during their operations (plication+patch, P/P, 19 cases) were compared with the patients receiving sole plication during the operation (P, 9 cases). The operations had been performed through a minimal length lateral thoracotomy incision (12-14 cm).

RESULTS

The mean age of the patients was 53.3+/-9.8 years. A high hemi-diaphragm (alone or associated with a blunt sinus or a wide mediastinum) was the most prominent chest X-ray (CXR) finding in 19 patients (68%). The postoperative mean forced expiratory volume in 1s (FEV(1)) value (2.1+/-0.7) and the dyspnoea score (1.8+/-0.7) were better than the preoperative values (1.7+/-0.6; 3.4+/-0.9, respectively). The average height of the diaphragm (7.8+/-3.1cm) was not correlated with the dyspnoea score and the FEV(1) value. Postoperative complications (4/28 or 14.3%) were minimal, excluding one respiratory insufficiency. The mean follow-up time was 23.4+/-17.8 months. Patients with congenital aetiology were younger, had higher diaphragms, had earlier operations after symptoms started and had better preoperative FEV(1) values. P/P operations were done later than P operations. The P/P method patients had shorter postoperative hospital stays than the P method patients. Two diaphragmatic events (recurrence and herniation) occurred after the operations were performed with the P method.

CONCLUSIONS

Buttressing the diaphragm by patch after the plication can protect from recurrence of a DE or any diaphragmatic insufficiency. Previous abdominal interventions may increase the complication rate after a DE operation.