Long term results of diaphragmatic plication for unilateral diaphragm paralysis.
OBJECTIVE
To examine whether diaphragmatic plication is an effective and lasting treatment option for non-malignant diaphragmatic paralysis.


METHODS
Nineteen patients who had undergone diaphragm plication (1983-1990) were recalled for interview, pulmonary function testing and chest X-ray.


RESULTS
There were 13 men and six women aged 24-73 (mean 55). Diaphragm paralysis was idiopathic (n=9), postsurgical (n=3), related to cervical spondylosis (n=4) and neck injury (n=2). Patients presented with breathlessness (18/19) or orthopnoea (1/19). Symptoms had lasted 3-60 months (mean 24 months). All patients had a raised hemidiaphragm on chest X-ray with paradoxical movement on ultrasound. Mean preoperative FVC was 71% predicted (range 38-93, SD 12.9) and mean FEV(1) was 67% predicted (range 33-90, SD 10.8). Supine lung volumes were 81% (mean) of sitting values. There were six right plications and 13 left. There were no postoperative deaths. One patient required re-plication. Follow-up (18/19 of original operated patients) ranged from 7-14 years (mean 10 years). Three patients had died of unrelated causes and one patient failed to attend long term follow-up, leaving 15 patients of the original 19 operated on. Positional change in lung volumes was not affected by surgery at early (6 week) or late (>5 year) follow-up. FVC, FEV(1), FRC and TLC improved by 10.1*, 11.8*, 16.9* and 9.2*%, respectively, at early follow-up and 11.8*, 15.4*, 26 and 13.3*% at late follow-up (*P<0.005 signed rank). Dyspnoea scores at long term follow-up improved 1 point (n=5), 2 points (n=5) and 3 points (n=2), remained unchanged (n=1) or dropped 1 point (n=2). Of the 15 patients followed up all but one who had been employed returned to work. 14/15 patients expressed satisfaction with their surgery.


CONCLUSIONS
Diaphragm plication is an effective procedure with lasting results.
Higgs
Simon M
SM
Royal Devon and Exeter NHS Trust, Barrack Road, Exeter, Devon EX2 5DW, UK.
Hussain
Afzal
A
Jackson
Mark
M
Donnelly
Raymund J
RJ
Berrisford
Richard G
RG
D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D020127:Recovery of Function; D012129:Respiratory Function Tests; D012133:Respiratory Paralysis / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome