title: Anterior diaphragmatic plication in mediastinal surgery: the "reefing the mainsail" technique.
abstract: Diaphragmatic plication is usually obtained by suturing the entire dome, which can be laborious when an anterior approach is used. The same result can be obtained by anchoring the redundant diaphragm to the anterior costal arch maneuver, which resembles the action of reefing the mainsail on the boom of a sailboat. Radiologic results have been analyzed from a series of 10 consecutive patients who underwent mediastinal surgery with phrenic nerve section. One week after surgery, no patient had an eventrated diaphragm on lateral chest roentgenogram. No lower lobe atelectasis was recorded in the series until discharge. This technique represents an alternative to classic diaphragmatic plication with three main advantages: (1) it does not require suturing of the posterior part of the dome, which can be difficult to reach when an anterior approach (sternotomy or hemi-clamshell) is used; (2) the presence of three sequential steps, which progressively increases diaphragmatic stretching and permits adjusting the tension of the dome; and (3) the possibility of standard plication is not precluded.
authors.affiliation: Thoracic Surgery Department, Istituto Nazionale dei Tumori, Milan, Italy. francesco.leo@istitutotumori.mi.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Leo
authors.forename: Paolo
authors.initials: P
authors.lastname: Girotti
authors.forename: Luca
authors.initials: L
authors.lastname: Tavecchio
authors.forename: Barbara
authors.initials: B
authors.lastname: Conti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Delledonne
authors.forename: Ugo
authors.initials: U
authors.lastname: Pastorino
mesh_terms: D003964:Diaphragm / Q000601:surgery*; D003965:Diaphragmatic Eventration / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies; D013536:Suture Techniques; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome