Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study.
BACKGROUND
This study seeks to evaluate results regarding the repair of diaphragmatic eventration using video-assisted thoracic surgery (VATS).


METHODS
We performed a prospective observational study including patients referred to us for surgical treatment of diaphragmatic eventration during a 12-year period. Clinical, radiologic, and functional data were prospectively recorded. VATS was performed with two thoracoports and a 4-cm mini-thoracotomy. Diaphragmatic plication was performed using two nonresorbable running sutures from periphery to the cardio-phrenic angle. Follow-up data (clinical examination, chest roentgenogram, lung function tests at 3, 6, 12 months, and annually thereafter) were also prospectively recorded.


RESULTS
Twelve patients (4 male adults, mean age 57.7 +/- 14.8 years) were operated on between 1992 and 2003. The left side was involved in 8 patients and the mean height of diaphragm elevation was 7.5 +/- 1.8 cm. All patients experienced symptoms related to the disease; in 2 patients the operation was carried out to achieve weaning from mechanical ventilation. The etiologic mechanism could be identified in 11 out of 12 patients (trauma, n = 9; Charcot-Marie disease, n = 1; calcified para-aortic nodes, n = 1). Mean operative time, drainage output, and hospital stay were 77 +/- 15 minutes, 0.8 +/- 04 L, and 3.4 +/- 0.7 days, respectively. No mortality was observed; 1 patient experienced postoperative pneumonia, which was treated using antibiotics. All patients experienced amelioration of symptoms and long-term lung function tests revealed a marked improvement of both the forced volume capacity and the forced expiratory volume at 1 second. No relapses were observed at follow-up chest roentgenogram.


CONCLUSIONS
Treatment using VATS is a safe and effective alternative to conventional surgery. Functional improvement persists at long-term follow-up.
Mouroux
Jérôme
J
Service de Chirurgie Thoracique, CHU de Nice, Hôpital Pasteur, Nice, France.
Venissac
Nicolas
N
Leo
Francesco
F
Alifano
Marco
M
Guillot
Françoise
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications; D002607:Charcot-Marie-Tooth Disease / Q000150:complications; D003965:Diaphragmatic Eventration / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010220:Para-Aortic Bodies / Q000473:pathology; D010791:Phrenic Nerve / Q000293:injuries; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D013147:Spirometry; D013536:Suture Techniques; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications