title: Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery.
abstract: OBJECTIVE
  Diaphragm plication is used to improve lung function and respiratory insufficiency in patients suffering from diaphragm paralysis. We assessed the efficacy of intra-operative unilateral diaphragm plication for prevention of postoperative pulmonary complications in patients, who underwent a phrenicotomy due to extended surgical intervention.
  
  
  METHODS
  Intra-operative unilateral diaphragm plication was performed in 13 patients, who underwent a unilateral phrenicotomy during an extended thoracic operation. Six patients had lung cancer, six had a mediastinal tumour and one had a mesothelioma. We retrospectively observed the postoperative clinical courses in the perioperative period and lung function results at 1 year after operation. The postoperative lung function was compared with the predicted postoperative lung function. In addition, we observed clinical symptoms and radiological findings of the follow-up period.
  
  
  RESULTS
  Ten (77%) of the cases revealed no postoperative complications, while three (23%) had pulmonary complications and two (15%) required prolonged mechanical ventilation. Diaphragm paralysis was not shown clinically and radiologically during the follow-up period. Postoperative lung function was similar to predicted postoperative lung function.
  
  
  CONCLUSIONS
  Unilateral diaphragm plication in a patient undergoing a unilateral phrenicotomy during an extended thoracic operation is effective to prevent postoperative pulmonary complications and to preserve postoperative lung function.
authors.affiliation: Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toshiteru
authors.initials: T
authors.lastname: Tokunaga
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Sawabata
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kadota
authors.forename: Tomoki
authors.initials: T
authors.lastname: Utsumi
authors.forename: Masato
authors.initials: M
authors.lastname: Minami
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Inoue
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Ohta
authors.forename: Meinoshin
authors.initials: M
authors.lastname: Okumura
mesh_terms: D000368:Aged; D002648:Child; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control*; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery; D008654:Mesothelioma / Q000601:surgery; D008875:Middle Aged; D010791:Phrenic Nerve / Q000601:surgery*; D011859:Radiography; D012133:Respiratory Paralysis / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult