Diaphragmatic paralysis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]
Overview
Surgery is not the first-line treatment option for patients with unilateral diaphragmatic paralysis. Surgery is usually reserved for patients with either dyspnea in strenous physical activity and patients with underlying severe pulmonary disease. Surgical plication of the involved hemi diaphragm can be considered for unilateral diaphragmatic paralysis. surgery in bilateral diaphragmatic paralysis can be done via neurolysis and nerve grafting.
Indications
- Surgery is not the first-line treatment option for patients with unilateral diaphragmatic paralysis . Surgery is usually reserved for patients with either:[1][2]
- Dyspnea in strenous physical activity
- Underlying severe pulmonary disease
Surgery
Unilateral diaphragmatic paralysis
- Surgical plication of the involved hemidiaphragm:[3][4]
- It is performed via thoracotomy, video-assisted thoracoscopic surgery (VATS) or laparoscopy.
- Creating folds in the hemidiaphragm and suturing them reduce mobilty of involved hemidiaphragm.
- Following surgery, the involved diaphragam does not paradoxically moved upward into the thorax during inspiration and ventilation will be improved in this way.
bilateral diaphragmatic paralysis
- Nerve surgery via neurolysis, nerve grafting[5]
Contraindications
Morbid obesity is contraindication to surgical plication[6]
References
- ↑ Versteegh MI, Braun J, Voigt PG, Bosman DB, Stolk J, Rabe KF, Dion RA (September 2007). "Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea". Eur J Cardiothorac Surg. 32 (3): 449–56. doi:10.1016/j.ejcts.2007.05.031. PMID 17658265.
- ↑ Ciccolella DE, Daly BD, Celli BR (September 1992). "Improved diaphragmatic function after surgical plication for unilateral diaphragmatic paralysis". Am. Rev. Respir. Dis. 146 (3): 797–9. doi:10.1164/ajrccm/146.3.797. PMID 1519867.
- ↑ Hüttl TP, Wichmann MW, Reichart B, Geiger TK, Schildberg FW, Meyer G (March 2004). "Laparoscopic diaphragmatic plication: long-term results of a novel surgical technique for postoperative phrenic nerve palsy". Surg Endosc. 18 (3): 547–51. doi:10.1007/s00464-003-8127-8. PMID 15108692.
- ↑ Wright CD, Williams JG, Ogilvie CM, Donnelly RJ (August 1985). "Results of diaphragmatic plication for unilateral diaphragmatic paralysis". J. Thorac. Cardiovasc. Surg. 90 (2): 195–8. PMID 3927067.
- ↑ Kaufman MR, Elkwood AI, Aboharb F, Cece J, Brown D, Rezzadeh K, Jarrahy R (June 2015). "Diaphragmatic reinnervation in ventilator-dependent patients with cervical spinal cord injury and concomitant phrenic nerve lesions using simultaneous nerve transfers and implantable neurostimulators". J Reconstr Microsurg. 31 (5): 391–5. doi:10.1055/s-0035-1549159. PMID 25868155.
- ↑ Petrovic M, Lahrmann H, Pohl W, Wanke T (February 2009). "Idiopathic diaphragmatic paralysis--satisfactory improvement of inspiratory muscle function by inspiratory muscle training". Respir Physiol Neurobiol. 165 (2–3): 266–7. doi:10.1016/j.resp.2008.11.010. PMID 19111633.