title: 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.
abstract: 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.
authors.affiliation: Euphrates University Hospital, Thoracic Surgery Department, 23119 Elazig, Turkey. abalci.journals@hotmail.com
authors.forename: Akin Eraslan
authors.initials: AE
authors.lastname: Balci
authors.forename: Mehmet Oğuzhan
authors.initials: MO
authors.lastname: Ozyurtkan
mesh_terms: D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000002:abnormalities / Q000293:injuries; D003965:Diaphragmatic Eventration / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome