[Fenestration of diaphragm for management of persistent postoperative pleural effusion: clinical experience and experiment in rabbits].
The management of persistent postoperative pleural effusion is still considered difficult. We report here our experience with such a case, successfully managed with fenestration of the diaphragm-the first of it's kind. Clinical Experience: A two-year-old boy with double outlet right ventricle, underwent right heart bypass procedure. Due to low output and high venous pressure, he was on ventilator until the 26th postoperative day. The pericardial and right pleural effusion persisted till the 60th postoperative day. Right phrenic nerve palsy and atelectasis of right lower lobe were suspected to contribute to it. We performed a plication of the right diaphragm and fenestration of the pericardium and right diaphragm. A T-shaped incision was made on the right diaphragm and the edges were trimmed and strengthened with non-absorbable suture into a circular shaped defect of 1.5 cm diameter. The defect was closed with a Dacron mesh allowing passage of fluid across. Pleural effusion decreased immediately and he was discharged a month after the procedure. Experimental Study: The above procedure was experimented in rabbits in whom a contrast medium injected into the pleural cavity could easily drain into the peritoneum through the fenestation, proved by fluoroscopy.


CONCLUSIONS
Fenestration of the diaphragm is an effective procedure to manage persistent pleural effusion.
Yoshii
S
S
Second Department of Surgery, Yamanashi Medical University, Japan.
Suzuki
S
S
Hosaka
S
S
Samuel
A
A
Takahashi
W
W
Okuwaki
H
H
Matsubara
H
H
Amashiro
N
N
Tada
Y
Y
D000818:Animals; D002675:Child, Preschool; D003964:Diaphragm / Q000601:surgery*; D004310:Double Outlet Right Ventricle / Q000601:surgery; D018610:Heart Bypass, Right; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011817:Rabbits; D012133:Respiratory Paralysis / Q000150:complications; D013526:Surgical Mesh