1
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Ko MJ, Song KM, Yoon HY. Clinical evaluation and surgical intervention for diaphragmatic eventration mimicking peritoneopericardial hernia in a cat. J Vet Sci 2024; 25:e19. [PMID: 38568821 PMCID: PMC10990918 DOI: 10.4142/jvs.23277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 04/05/2024] Open
Abstract
A 2-year-old spayed female British Shorthair cat presented with an increased frequency and duration of cough since infant period. Based on radiographic, ultrasonographic, and computed tomography findings, peritoneopericardial diaphragmatic hernia was considered so that repair surgery was planned. During celiotomy, lax diaphragm was identified instead of defect. Transabdominal diaphragmatic plication was performed to resolve lax diaphragm and to prevent recurrence by overlapping relatively normal part of diaphragm. Diagnosed with diaphragmatic eventration postoperatively, the cat showed improvement in clinical signs and imaging results. Transabdominal diaphragmatic plication is a suitable treatment; the patient maintained normally during a 14-month follow-up period.
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Affiliation(s)
- Min-Jung Ko
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | | | - Hun-Young Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
- KU Center for Animal Blood Medical Science, Konkuk University, Seoul 05030, Korea.
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2
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Topolnitskiy EB, Shefer NA, Yunusov AN. [Quality of life in patients with postoperative unilateral diaphragm relaxation]. Khirurgiia (Mosk) 2024:21-27. [PMID: 38785235 DOI: 10.17116/hirurgia202405121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To evaluate the quality of life before and after video-assisted thoracoscopic plication of relaxed dome of diaphragm. MATERIAL AND METHODS The study included 17 patients operated on for unilateral relaxation of diaphragm. We analyzed quality of life in preoperative period, 1, 3, 6 and 12 months after surgery using the SF-36 and EuroQ-5D-5L questionnaires. To assess the impact of abnormality on respiratory function, we estimated diaphragm position, spirometry data and SGRQ scores. RESULTS FVC increased by 16.5% after 1 month, 19.5% after 6 months and 20.1% after 12 months. In addition, FEV1 significantly increased (by 12.6% after 1 month, 10.1% after 6 months and 12.7% after 12 months). Mean values of diaphragm elevation in postoperative period decreased by 25.5-25.6%. According to the SF-36 and EuroQ-5D-5L questionnaires, physical and psychological health components significantly increased within a month after surgical treatment. According to the SGRQ questionnaire, influence of disease on overall status decreased a month after surgery as evidences by lower total score (p<0.05). CONCLUSION Objective and survey data revealed significant improvement in quality of life after surgery. A trend towards higher quality of life was demonstrated by all questionnaires in a month after surgery.
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Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia
- Tomsk Regional Clinical Hospital, Tomsk, Russia
- Tomsk State University, Tomsk, Russia
| | - N A Shefer
- Siberian State Medical University, Tomsk, Russia
- Tomsk Regional Clinical Hospital, Tomsk, Russia
| | - A N Yunusov
- Tomsk Regional Clinical Hospital, Tomsk, Russia
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3
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Forter-Chee-A-Tow N, Smith A. Case report: repair of eventration of the diaphragm in an octogenarian. J Surg Case Rep 2023; 2023:rjad581. [PMID: 37901603 PMCID: PMC10602662 DOI: 10.1093/jscr/rjad581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Eventration of the diaphragm is a cephalad displacement of the diaphragm because of congenital or acquired causes. The diaphragm maintains its anatomical continuity and normal attachments. It may be partial or complete and unilateral or bilateral. Most adult presentations are asymptomatic, but patients may present with respiratory, gastrointestinal, or cardiac symptoms. Surgical repair is indicated in the symptomatic patient with the most common being diaphragmatic plication. We present surgical repair of a symptomatic left diaphragmatic eventration in an octogenarian.
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Affiliation(s)
| | - Alan Smith
- Department of Cardiovascular Services, Queen Elizabeth Hospital, Bridgetown 11123, Barbados
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4
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Aslamzai M, Rahmani FR, Hakimi T, Mukhlis AH, Froogh BA. Right-side diaphragmatic eventration with atrial septa defect and cleft palate in an infant: a case report. J Med Case Rep 2023; 17:183. [PMID: 37081543 PMCID: PMC10120111 DOI: 10.1186/s13256-023-03910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/20/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Congenital right-side diaphragmatic eventration with atrial septal defect and cleft palate is a rare congenital anomaly. CASE PRESENTATION We present a rare case of congenital right-sided diaphragmatic eventration along with atrial septal defect, cleft palate, pneumonia, and undernutrition in a 3-month-old Asian and Afghan girl. The clinical features were observed in the third month of life, and the diagnosis of these anomalies was established by the patient's history, physical examination, chest X-ray, thoracic computed tomography, and echocardiography. Her condition was good after supportive treatment. Since the index case of diaphragmatic eventration was associated with congenital heart disease, cleft palate, and parental consanguinity, a genetic basis may have played an important role in the pathogenesis of this anomaly. CONCLUSION Eventration of the diaphragm may be diagnosed in early infancy, and genetic factors may contribute to its pathogenesis.
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Affiliation(s)
- Mansoor Aslamzai
- Department of Neonatology, Kabul University of Medical Sciences, 3rd District, Kabul, 1003, Afghanistan.
| | - Fazal Rahman Rahmani
- Department of Abdominal Surgery, Kabul University of Medical Sciences, 3rd District, Kabul, 1003, Afghanistan
| | - Turyalai Hakimi
- Department of Pediatrics Surgery, Kabul University of Medical Sciences, 3rd District, Kabul, 1003, Afghanistan
| | - Abdul Hakim Mukhlis
- Department of Neonatology, Kabul University of Medical Sciences, 3rd District, Kabul, 1003, Afghanistan
| | - Basir Ahmad Froogh
- Department of Neonatology, Kabul University of Medical Sciences, 3rd District, Kabul, 1003, Afghanistan
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5
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Erin SA, Gololobov GY, Yurkyliev NA, Chicherina MA, Burmistrov AI, Gadlevskiy GS, Ovchinnikova UR, Gorbacheva IV, Gallyamov EA. THE DIAPHRAGM EVENTRATION UNDER THE GUISE OF RECURRENT PARAESOPHAGEAL HIATAL HERNIA. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-4-70-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The clinical case presented in this article illustrates one of the serious iatrogenic complications of Nissen fundoplication: diaphragmatic eventration. A 65-year-old patient was diagnosed with recurrent paraesophageal hiatal hernia. Intraoperatively, it was treated as diaphragmatic eventration. Laparoscopic Nissen refundoplication, suturing of the diaphragm defect was performed. The patient was discharged in satisfactory condition on the 5th day.
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Affiliation(s)
- S. A. Erin
- Medical Scientific and Educational Center of Moscow State University named after M.V. Lomonosov
| | - G. Yu. Gololobov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - M. A. Chicherina
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. I. Burmistrov
- National Medical Research Center of Surgery named after A.V. Vishnevsky
| | - G. S. Gadlevskiy
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - U. R. Ovchinnikova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I. V. Gorbacheva
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. A. Gallyamov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
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6
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Hebbale R, Ramachandran K, R V, Cherukumudi A. Congenital unilateral diaphragmatic eventration in adults – a case series with a brief literature review. HEART, VESSELS AND TRANSPLANTATION 2022. [DOI: 10.24969/hvt.2022.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: The aim of this article was to present the results of thoracotomy performed in three symptomatic adult patients with congenital diaphragm eventration in the light of current literature data.
Methods: Along with representation of the surgical management of each case, a brief review of literature was performed.
Results and Conclusion: Diaphragmatic eventration is a rare clinical entity that may be congenital or acquired. Surgery, which may be open or endoscopic, is the primary treatment modality for symptomatic patients.
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7
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Selzer EB, Biblowitz K, Yoo EJ. Diaphragmatic Eventration and Positive Pressure Ventilation. Am J Respir Crit Care Med 2022; 206:347-348. [PMID: 35584323 DOI: 10.1164/rccm.202109-2110im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Evan B Selzer
- Thomas Jefferson University Sidney Kimmel Medical College, 12313, Philadelphia, Pennsylvania, United States
| | - Kathleen Biblowitz
- Thomas Jefferson University, 6559, Philadelphia, Pennsylvania, United States
| | - Erika J Yoo
- Thomas Jefferson University, 6559, Medicine, Philadelphia, Pennsylvania, United States;
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8
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Gritsiuta AI, Gordon M, Bakhos CT, Abbas AE, Petrov RV. Minimally Invasive Diaphragm Plication for Acquired Unilateral Diaphragm Paralysis: A Systematic Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:180-190. [PMID: 35549933 DOI: 10.1177/15569845221097761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Diaphragm paralysis is a relatively uncommon entity that can be both congenital and acquired in nature. While commonly asymptomatic, it can also cause a significant decrease in pulmonary function and reserve, particularly in patients with underlying pulmonary diseases. Our aim was to summarize the current literature regarding the minimally invasive techniques used in the surgical correction of acquired diaphragm paralysis via traditional and robotic minimally invasive approaches. Methods: We conducted a systematic review of available literature using the Cochrane methodology and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 6,561 citations were identified through initial database and reference searches, of which 90 articles met the inclusion criteria for review. After further assessment, 33 appropriate full-text studies were selected for the review. Of the selected publications, the majority represented case reports and single-center retrospective studies with level of evidence 4. Only 1 level 2b study (individual cohort study) was identified, comparing minimally invasive and open approaches. Conclusions: Each of the minimally invasive approaches has its unique benefits and disadvantages, which are summarized and delineated in this article. Ultimately, no preferred method of diaphragm plication for diaphragm paralysis can be recommended at this time based on clinical data. The choice of procedure and surgical approach continues to be selected based on the surgeon's experience and preference.
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Affiliation(s)
- Andrei I Gritsiuta
- Department of Surgical Services, 6595University of Pittsburgh Medical Center, PA, USA
| | - Matthew Gordon
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Charles T Bakhos
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Abbas E Abbas
- Department of Thoracic Oncology, 12321Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Roman V Petrov
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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9
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Fiott DL, Gauci J, Pace Bardon M, Balzan M. Type 2 respiratory failure secondary to left hemidiaphragmatic paralysis. Breathe (Sheff) 2022; 18:210165. [PMID: 36338253 PMCID: PMC9584595 DOI: 10.1183/20734735.0165-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
A 73-year-old man presented to the emergency department with worsening orthopnoea and exertional dyspnoea. He denied any other cardiorespiratory symptoms. The patient had a body mass index (BMI) of 23.3 kg·m−2 (height 163 cm, weight 62 kg). Lung function tests 3 months before admission showed a ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) of 88%. He had a past medical history of hypothyroidism, for which he was on levothyroxine 50 μg daily, and type 2 diabetes mellitus, for which he was on metformin 500 mg twice daily. Past surgical history included a gastrectomy 3 years prior to admission performed for gastric cancer, which was subsequently complicated by a subphrenic abscess, pancreatitis and residual pancreatic insufficiency. The patient was a lifelong non-smoker, worked in construction, reared birds as a hobby, and lived in an urban area. He was not on any other medication. This case describes an uncommon presentation of type 2 respiratory failure secondary to left hemidiaphragmatic paralysis. Emphasis is on the multitude of possible causes of hemidiaphragmatic paralysis and how to manage such a presentation.https://bit.ly/3Mcd2XI
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10
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Horiguchi K, Lee SW, Shimizu T, Arima J, Taniguchi K, Hagihara S, Komeda K, Uchiyama K. Recurrence of a congenital diaphragmatic hernia 57 years postoperatively: A case report and review of the literature. Medicine (Baltimore) 2022; 101:e28650. [PMID: 35060556 PMCID: PMC8772697 DOI: 10.1097/md.0000000000028650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Postoperative recurrence of congenital diaphragmatic hernia (CDH) in adults is very rare. There is currently no precedent and no established treatment. We encountered a case of CDH which recurred 57 years, postoperatively. PATIENT CONCERNS A 57-year-old man with dyspnea on exertion was referred to our hospital. He had undergone surgery at the same hospital for CDH when he was 46 days old. DIAGNOSIS AND INTERVENTIONS Laboratory studies, except diagnostic imaging and spirometry, were otherwise within normal limits. He was diagnosed with recurrent CDH based on computed tomography and underwent laparoscopic surgery. OUTCOMES His postoperative course was uneventful, and there was no recurrence on follow-up. LESSONS We reported our encounter with a case of recurrent CDH, more than 50 years after the initial surgery. When managing diaphragmatic hernias, prompt surgical treatment, with consideration to prior surgical history for CDH, leads to satisfactory results.
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Affiliation(s)
- Kohei Horiguchi
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Tetsunosuke Shimizu
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Jun Arima
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Kohei Taniguchi
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
- Translational Research Program, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Seita Hagihara
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Koji Komeda
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
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11
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Diaphragmatic eventration as a first sign of Scimitar syndrome. Cardiol Young 2021; 31:1870-1872. [PMID: 33941297 DOI: 10.1017/s1047951121001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diaphragmatic eventration is an anomaly of the diaphragm. In Scimitar syndrome, a curved-shaped anomalous pulmonary venous drainage is seen. Association between these conditions is rare. We present a newborn with diaphragmatic eventration, whose diagnosis of Scimitar syndrome was made after surgical repair. Scimitar syndrome is a congenital disorder often associated with other heart and lungs anomalies. Diagnosis can be fortuitous but with important prognostic features.
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12
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Huang D, Tang J, Wang F, Li L, Liang J, Zhuang L, Yang Q, Zeng J, Liu W. The feasibility and safety of same-day surgery for diaphragmatic eventration by minithoracotomy in children. Pediatr Surg Int 2021; 37:1215-1220. [PMID: 33864497 DOI: 10.1007/s00383-021-04907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The diaphragmatic plication procedure by thoracoscopy has gradually become standard treatment for diaphragmatic eventration (DE). However, thoracoscopic diaphragmatic plication is difficult to manipulate and the surgical learning curve is long. This study aimed to demonstrate the feasibility and safety of same-day surgery for DE by minithoracotomy in children. METHODS From December 2017 to December 2019, we included 22 patients who underwent diaphragmatic plication of DE in the Department of Pediatric Thoracic Surgery at the Guangzhou Women and Children's Medical Center. A total of 10 patients underwent diaphragmatic plication by minithoracotomy and 12 patients underwent thoracoscopic plication. The perioperative condition and postoperative follow-up were evaluated, respectively. RESULTS The age, sex, and weight were no different in the minithoracotomy group versus the thoracoscopy group (P > 0.05). The intraoperative time, blood loss volume, and postoperative hospital stay of the minithoracotomy group were significantly less than that of the thoracoscopy group (31.10 ± 4.70 min vs. 72.08 ± 22.8 min; 1.20 ± 0.42 ml vs. 2.58 ± 1.67 ml; and 1.00 ± 0.00 days vs. 6.00 ± 2.95 days, respectively, all P < 0.05). The eventration levels in these two groups were significantly different in the perioperative and postoperative periods as detected by chest X-ray. No chest tubes were inserted and no recurrence of DE occurred in the thoracoscopy group through the postoperative follow-up of at least 6 months. CONCLUSION Same-day surgery by minithoracotomy as a treatment for DE was feasible and safe with less operative time, less blood loss, and low recurrence. Same-day surgery for DE was attributed to a quick recovery. More prospective studies are necessary to further explore the consequences of same-day surgery for DE by minithoracotomy.
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Affiliation(s)
- Dongmei Huang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Jue Tang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Fenghua Wang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Le Li
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Jianhua Liang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Linwei Zhuang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Qinglin Yang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Jiahang Zeng
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Wei Liu
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China.
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Laghi FA, Saad M, Shaikh H. Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction. BMC Pulm Med 2021; 21:85. [PMID: 33722215 PMCID: PMC7958108 DOI: 10.1186/s12890-021-01441-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/19/2021] [Indexed: 12/25/2022] Open
Abstract
Diaphragm muscle dysfunction is increasingly recognized as an important element of several diseases including neuromuscular disease, chronic obstructive pulmonary disease and diaphragm dysfunction in critically ill patients. Functional evaluation of the diaphragm is challenging. Use of volitional maneuvers to test the diaphragm can be limited by patient effort. Non-volitional tests such as those using neuromuscular stimulation are technically complex, since the muscle itself is relatively inaccessible. As such, there is a growing interest in using imaging techniques to characterize diaphragm muscle dysfunction. Selecting the appropriate imaging technique for a given clinical scenario is a critical step in the evaluation of patients suspected of having diaphragm dysfunction. In this review, we aim to present a detailed analysis of evidence for the use of ultrasound and non-ultrasound imaging techniques in the assessment of diaphragm dysfunction. We highlight the utility of the qualitative information gathered by ultrasound imaging as a means to assess integrity, excursion, thickness, and thickening of the diaphragm. In contrast, quantitative ultrasound analysis of the diaphragm is marred by inherent limitations of this technique, and we provide a detailed examination of these limitations. We evaluate non-ultrasound imaging modalities that apply static techniques (chest radiograph, computerized tomography and magnetic resonance imaging), used to assess muscle position, shape and dimension. We also evaluate non-ultrasound imaging modalities that apply dynamic imaging (fluoroscopy and dynamic magnetic resonance imaging) to assess diaphragm motion. Finally, we critically review the application of each of these techniques in the clinical setting when diaphragm dysfunction is suspected.
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Affiliation(s)
- Franco A Laghi
- Department of Internal Medicine, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA
| | - Marina Saad
- Department of Biomedical and Clinical Sciences (DIBIC), Division of Pulmonary Diseases, University of Milan, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, V. G.B. Grassi, 74, 20157, Milan, Italy
| | - Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital (111N), 5th Avenue and Roosevelt Road, Hines, IL, 60141, USA. .,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL, 60153, USA.
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14
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Doi K, Sem SH, Ghanghurde B, Hattori Y, Sakamoto S. Pearls and Pitfalls of Phrenic Nerve Transfer for Shoulder Reconstruction in Brachial Plexus Injury. J Brachial Plex Peripher Nerve Inj 2021; 16:e1-e9. [PMID: 33584849 PMCID: PMC7875611 DOI: 10.1055/s-0041-1722979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/12/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives
The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5–8 palsies, and its pulmonary complications.
Methods
Forty-four out of 127 BPI patients with total and C5–8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification. The predisposing factors to develop pulmonary complications in those patients were examined as well.
Results
PNT to SSN provided a better shoulder range of motion significantly as compared with nerve transfer from C5 root and contralateral C7. The results between PNT and spinal accessory nerve transfer to SSN were comparable in all directions of shoulder motions. There were no significant respiratory symptoms in majority of the patients including six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing factors for poorer pulmonary performance were identified, which were age and body mass index, with cut-off values of younger than 32 years old and less than 23, respectively.
Conclusions
PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder function in BPI patients with total or C5–8 palsy. The postoperative pulmonary complications can be prevented with vigilant patient selection.
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Affiliation(s)
- Kazuteru Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
| | - Sei Haw Sem
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan.,Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Bipin Ghanghurde
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan.,Hand surgery, Kusum Orthopedic Centre, Mumbai, Maharashtra, India.,Hand surgery, Wadia Hospital, Mumbai, Maharashtra, India.,Hand surgery, Surya Hospital, Mumbai, Maharashtra, India
| | - Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
| | - Sotetsu Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Yamaguchi Prefecture, Japan
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15
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Cleal L, McHaffie SL, Lee M, Hastie N, Martínez-Estrada OM, Chau YY. Resolving the heterogeneity of diaphragmatic mesenchyme: a novel mouse model of congenital diaphragmatic hernia. Dis Model Mech 2021; 14:14/1/dmm046797. [PMID: 33735101 PMCID: PMC7859704 DOI: 10.1242/dmm.046797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/03/2020] [Indexed: 01/17/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a relatively common developmental defect with considerable mortality and morbidity. Formation of the diaphragm is a complex process that involves several cell types, each with different developmental origins. Owing to this complexity, the aetiology of CDH is not well understood. The pleuroperitoneal folds (PPFs) and the posthepatic mesenchymal plate (PHMP) are transient structures that are essential during diaphragm development. Using several mouse models, including lineage tracing, we demonstrate the heterogeneous nature of the cells that make up the PPFs. The conditional deletion of Wilms tumor 1 homolog (Wt1) in the non-muscle mesenchyme of the PPFs results in CDH. We show that the fusion of the PPFs and the PHMP to form a continuous band of tissue involves movements of cells from both sources. The PPFs of mutant mice fail to fuse with the PHMP and exhibit increased RALDH2 (also known as ALDH1A2) expression. However, no changes in the expression of genes (including Snai1, Snai2, Cdh1 and Vim) implicated in epithelial-to-mesenchymal transition are observed. Additionally, the mutant PPFs lack migrating myoblasts and muscle connective tissue fibroblasts (TCF4+/GATA4+), suggesting possible interactions between these cell types. Our study demonstrates the importance of the non-muscle mesenchyme in development of the diaphragm.
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Affiliation(s)
- Louise Cleal
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Sophie L McHaffie
- Molecular Pathology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - Martin Lee
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Nick Hastie
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Ofelia M Martínez-Estrada
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, Av. Diagonal, 643, 08028 Barcelona, Spain.,Institute of Biomedicine (IBUB), University of Barcelona, Barcelona 08028, Spain
| | - You-Ying Chau
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
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Zhang G, Wang L, Wu Y, Shen G. Uniportal Video-Assisted Thoracoscopic Stapled Resection of Adult Diaphragmatic Eventration. Ann Thorac Surg 2020; 110:e135-e137. [PMID: 32283086 DOI: 10.1016/j.athoracsur.2020.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022]
Abstract
Surgery for an elevated diaphragm in adults is indicated only for patients with related severe dyspnea, orthopnea, or gastrointestinal problems. Experience in surgically treating eventration in adulthood is limited. Currently, diaphragmatic plication is the most frequently employed technique and should be attempted with minimally invasive approaches. Herein, we report 3 cases of diaphragmatic eventration managed through uniportal video-assisted thoracoscopic surgery stapled resection. These successful attempts provide a technically simple and feasible alternative for the management of diaphragmatic eventration.
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Affiliation(s)
- Guofei Zhang
- Department of Thoracic Surgery, Second Affiliated Hospital of the Zhejiang University School of Medicine, Hangzhou, China
| | - Lian Wang
- Department of Thoracic Surgery, Second Affiliated Hospital of the Zhejiang University School of Medicine, Hangzhou, China
| | - Yimin Wu
- Department of Thoracic Surgery, Second Affiliated Hospital of the Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Shen
- Department of Thoracic Surgery, Second Affiliated Hospital of the Zhejiang University School of Medicine, Hangzhou, China.
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Fujii T, Haruta S, Ohkura Y, Honda A, Kobayashi N, Tanaka T, Ueno M, Udagawa H. Laparoscopic distal gastrectomy in a patient with gastric cancer complicated by eventration of the diaphragm: A case report. Asian J Endosc Surg 2019; 12:318-321. [PMID: 30411524 DOI: 10.1111/ases.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/18/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Abstract
Diaphragmatic eventration refers to an abnormal elevation of the diaphragm. Here, we report the case of a patient with gastric cancer who underwent successful laparoscopic distal gastrectomy despite the presence of diaphragmatic eventration. The patient was a 72-year-old man diagnosed with early gastric cancer in the antrum, as detected by upper gastrointestinal endoscopy. Preoperative imaging revealed an elevation of the left side of the diaphragm, which was diagnosed as diaphragmatic eventration. Laparoscopic surgery is beneficial for obtaining an optimal field of view. However, there are critical points that must be considered when laparoscopic distal gastrectomy is performed in patients with gastric cancer complicated by diaphragmatic eventration. There were difficulties that affected manipulation because the elevated diaphragm drew the intraperitoneal organs into the thoracic cavity, causing displacement of the normal anatomical position. We found it beneficial to secure the lesser curvature of the stomach given the possible effects of gastric deformation.
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Affiliation(s)
- Takatsugu Fujii
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shusuke Haruta
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yu Ohkura
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
| | - Aya Honda
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
| | - Nao Kobayashi
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tsuyoshi Tanaka
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Ueno
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
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Abstract
Pathologic processes that involve the central nervous system, phrenic nerve, neuromuscular junction, and skeletal muscle can impair diaphragm function. When these processes are of sufficient severity to cause diaphragm dysfunction, respiratory failure may be a consequence. This article reviews basic diaphragm anatomy and physiology and then discusses diagnostic and therapeutic approaches to disorders that result in unilateral or bilateral diaphragm dysfunction. This discussion provides a context in which disorders of the diaphragm and their implications on respiratory function can be better appreciated.
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Affiliation(s)
- F Dennis McCool
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA.
| | - Kamran Manzoor
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA
| | - Taro Minami
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA
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Right Diaphragmatic Eventration with an Intrathoracic Kidney: Case Report and Review of the Literature. Case Rep Surg 2018; 2018:2631391. [PMID: 30631630 PMCID: PMC6304889 DOI: 10.1155/2018/2631391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/25/2018] [Indexed: 11/17/2022] Open
Abstract
We aimed to review the publications on the diagnosis of diaphragmatic eventration and report on the clinical presentation and surgical treatment of a female patient aged 17 years. The present case, though quite infrequent, shows the presence of an ectopic thoracic kidney on the right side. The clinical features included dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years; additionally, the patient had episodes of bronchial asthma since her childhood. The right hemithorax presented invasion of the thin loops, right colon, and kidney. The treatment approach was laparoscopic followed by thoracotomy using a dual mesh. The intrathoracic kidney remained in place. The outcome was satisfactory. Diaphragmatic eventration associated with thoracic renal ectopia is a very rare entity, considering the age, sex, and right location of the condition. It represents a clinical and diagnostic challenge; clinicians, radiologists, and surgeons must be alert with a high degree of suspicion in order to correlate symptoms and imaging findings and understand the etiopathogenesis. In addition, they should plan an adequate and individualized surgical repair making use, as far as possible, of the minimally invasive procedures that are currently used.
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Grigorchuk AY, Bazarov DV, Vyzhigina MA, Kavochkin AA, Kabakov DG. [Diaphragm relaxation surgery: since B.V. Petrovsky to the present day]. Khirurgiia (Mosk) 2018:60-66. [PMID: 29992929 DOI: 10.17116/hirurgia2018760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Yu Grigorchuk
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - D V Bazarov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - M A Vyzhigina
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - A A Kavochkin
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - D G Kabakov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
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21
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Double diaphragmatic contour. Abdom Radiol (NY) 2018; 43:1277-1278. [PMID: 28828508 DOI: 10.1007/s00261-017-1293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
AIM To develop examination algorithm and to determine the indications for various options for surgical treatment. MATERIAL AND METHODS It is presented analysis of surgical treatment of 25 patients with unilateral diaphragm relaxation for the period from 1963 to 2016. There were 15 men and 10 women aged from 39 to 65 years. Diagnosis included predominantly radiological methods. All patients were operated openly through thoracotomy. Procedure consisted of creation of new diaphragmatic cupola at the usual level with two flaps of diaphragm and prosthesis between them. In 12 (48%) patients who were operated before 1990 xenopericardial patch was used. Further, synthetic materials (Teflon, polypropylene) were preferred. RESULTS Postoperative morbidity and mortality was 20% (n=6) and 4% (n=1) respectively. Long-term results were followed-up within terms from 8 months to 12 years. Recurrent relaxation was absent. Most of patients had improved dyspnea, increased vital capacity and FEV1 in long-term period. Certain and general values of SF-36 life quality questionnaire were high in long-term postoperative period and similar to those in general population.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - M A Khetagurov
- Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Burdenko Clinic of Faculty Surgery, Moscow, Russia
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23
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Shwaartz C, Duggan E, Lee DS, Divino CM, Chin EH. Diaphragmatic eventration presenting as a recurrent diaphragmatic hernia. Ann R Coll Surg Engl 2017; 99:e196-e199. [PMID: 28853592 DOI: 10.1308/rcsann.2016.0342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diaphragmatic eventration is an uncommon condition, usually discovered incidentally in asymptomatic patients. Even in symptomatic patients, the diagnosis can be challenging and should be considered among the differential diagnoses of diaphragmatic hernia. The correct diagnosis can often only be made in surgery. We describe the case of a 31-year-old patient with diaphragmatic eventration that was misdiagnosed as a recurrent congenital diaphragmatic hernia and review the corresponding literature.
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Affiliation(s)
- C Shwaartz
- Icahn School of Medicine at Mount Sinai , New York , US
| | - E Duggan
- Icahn School of Medicine at Mount Sinai , New York , US
| | - D S Lee
- Icahn School of Medicine at Mount Sinai , New York , US
| | - C M Divino
- Icahn School of Medicine at Mount Sinai , New York , US
| | - E H Chin
- Icahn School of Medicine at Mount Sinai , New York , US
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24
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Demos DS, Berry MF, Backhus LM, Shrager JB. Video-assisted thoracoscopic diaphragm plication using a running suture technique is durable and effective. J Thorac Cardiovasc Surg 2017; 153:1182-1188. [DOI: 10.1016/j.jtcvs.2016.11.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/15/2016] [Accepted: 11/24/2016] [Indexed: 11/27/2022]
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25
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Zwischenberger BA, Kister N, Zwischenberger JB, Martin JT. Laparoscopic Robot-Assisted Diaphragm Plication. Ann Thorac Surg 2016; 101:369-71. [DOI: 10.1016/j.athoracsur.2015.05.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/09/2015] [Accepted: 05/26/2015] [Indexed: 10/22/2022]
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Alshorbagy A, Mubarak Y. Open Transthoracic Plication of the Diaphragm for Unilateral Diaphragmatic Eventration in Infants and Children. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:307-10. [PMID: 26509123 PMCID: PMC4622030 DOI: 10.5090/kjtcs.2015.48.5.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 07/28/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
Abstract
Background To evaluate our experience of early surgical plication for diaphragmatic eventration (DE) in infancy and childhood. Methods This study evaluated infants and children with symptomatic DE who underwent plication through an open transthoracic approach in our childhood development department between January 2005 and December 2012. Surgical plication was performed in several rows using polypropylene U-stitches with Teflon pledgets. Results The study included 12 infants and children (7 boys and 5 girls) with symptomatic DE (9 congenital and 3 acquired). Reported symptoms included respiratory distress (91.7%), wheezing (75%), cough (66.7%), and recurrent pneumonia (50%). Preoperative mechanical ventilatory support was required in 41.7% of the patients. The mean length of hospital stay was 6.3±2.5 days. The mean follow-up period was 24.3±14.5 months. Preoperative symptoms were immediately relieved after surgery in 83.3% of patients and persisted in 16.7% of patients one year after surgery. All patients survived to the end of the two-year follow-up and none had recurrence of DE. Conclusion Early diagnosis and surgical plication of the diaphragm for symptomatic congenital or acquired diaphragmatic eventration offers a good clinical outcome with no recurrence.
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Affiliation(s)
| | - Yasser Mubarak
- Cardiothoracic Surgery Department, Minia University Hospital
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27
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Snyder CW, Walford NE, Danielson PD, Chandler NM. A simple thoracoscopic plication technique for diaphragmatic eventration in neonates and infants: technical details and initial results. Pediatr Surg Int 2014; 30:1013-6. [PMID: 25139157 DOI: 10.1007/s00383-014-3580-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Existing minimal-access surgical approaches for correction of symptomatic diaphragmatic eventration may be technically difficult in neonates and infants. We report technical details and initial outcomes of a novel, simple thoracoscopic repair technique. METHODS The technique uses one 3-mm camera port, a 3-mm instrument incision without a port, and an 18-gauge spinal needle, which is passed through the chest wall into the pleural space. The excess diaphragm is first plicated over the needle, after which a non-absorbable suture is passed through the needle and tied extracorporeally. The needle is passed repeatedly until the desired degree of tension is achieved. A retrospective review was performed for all patients undergoing repair by this technique. RESULTS Nine patients have undergone thoracoscopic plication at a median age of 3 months (range 0.2-13.2 mos.) and a median weight of 4.5 kg (range 2.3-8.2 kg). No organ injuries or conversions to thoracotomy occurred. Median operative time was 60 min. Patients repaired beyond the neonatal period were extubated in the operating room. There were two post-operative pneumothoraces. No recurrences have been seen at a mean follow-up of 17 months. CONCLUSION This technique of thoracoscopic diaphragm plication is safe, effective, and technically straightforward in neonates and infants.
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Affiliation(s)
- Christopher W Snyder
- Division of Pediatric Surgery, All Children's Hospital, John Hopkins University School of Medicine, St. Petersburg, FL, USA,
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28
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Rombolá CA, Genovés Crespo M, Tárraga López PJ, García Jiménez MD, Honguero Martínez AF, León Atance P, Rodríguez Ortega CR, Triviño Ramírez A, Rodríguez Montes JA. Is video-assisted thoracoscopic diaphragmatic plication a widespread technique for diaphragmatic hernia in adults? Review of the literature and results of a national survey. Cir Esp 2014; 92:453-62. [PMID: 24602484 DOI: 10.1016/j.ciresp.2013.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 02/01/2023]
Abstract
Diaphragmatic plication is the most accepted treatment for symptomatic diaphragmatic hernia in adults. The fact that this pathology is infrequent and this procedure not been widespread means that this is an exceptional technique in our field. To estimate its use in the literature, we carried out a review in English and Spanish, to which we added our series. We found only six series that contribute 59 video-assisted mini-thoractomy for diaphragmatic plications in adults, and none in Spanish. Our series will be the second largest with 18 cases. Finally, we conducted a survey in all the Spanish Thoracic Surgery units in Spain: none reported more than 10 cases operated by thoracoscopy in the last 8 years (except our series) and most continue employing thoracotomy as the main approach. We believe that many patients with symptomatic diaphragmatic hernia could benefit from the use of such techniques.
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Affiliation(s)
- Carlos A Rombolá
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - Marta Genovés Crespo
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | | | | | - Pablo León Atance
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | - Ana Triviño Ramírez
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, Albacete, España
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Le Pimpec-Barthes F, Pricopi C, Mordant P, Arame A, Badia A, Grand B, Bagan P, Hernigou A, Riquet M. [Diaphragmatic palsy and dysfunction: from physiology to surgery]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:95-107. [PMID: 24566026 DOI: 10.1016/j.pneumo.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 06/03/2023]
Abstract
The clinical presentations of diaphragm dysfunctions vary according to etiologies and unilateral or bilateral diseases. Elevation of the hemidiaphragm from peripheral origins, the most frequent situation, requires a surgical treatment only in case of major functional impact. Complete morphological and functional analyses of the neuromuscular chain and respiratory tests allow the best selection of patients to be operated. The surgical procedure may be proposed only when the diaphragm dysfunction is permanent and irreversible. Diaphragm plication for eventration through a short lateral thoracotomy, or sometimes by videothoracoscopy, is the only procedure for retensioning the hemidiaphragm. This leads to a decompression of intrathoracic organs and a repositioning of abdominal organs without effect on the hemidiaphragm active contraction. Morbidity and mortality rates after diaphragm plication are very low, more due to the patient's general condition than to surgery itself. Functional improvements after retensioning for most patients with excellent long-term results validate this procedure for symptomatic patients. In case of bilateral diseases, very few bilateral diaphragm plications have been reported. Some patients with diaphragm paralyses from central origins become permanently dependent on mechanical ventilation whereas their lungs, muscles and nerves are intact. In patients selected by rigorous neuromuscular tests, a phrenic pacing may be proposed to wean them from respirator. Two main indications have been validated: high-level tetraplegia above C3 and congenital alveolar hypoventilation from central origin. After progressive reconditioning of the diaphragm muscles following phrenic pacing at thoracic level, more than 90% of patients can be weaned from respirator within a few weeks. This weaning improves the quality of life with more physiological breathing, restored olfaction, better sleep and better speech. The positive impact of diaphragm stimulation has also been evaluated in other degenerative neurological diseases, particularly the amyotrophic lateral sclerosis. For either central or peripheral diaphragm dysfunctions, a successful surgical treatment lies on a strict preoperative selection of patients.
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Affiliation(s)
- F Le Pimpec-Barthes
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - C Pricopi
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - P Mordant
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Arame
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Badia
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - B Grand
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - P Bagan
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Hernigou
- Service de radiologie, hôpital européen Georges-Pompidou, université Paris-Descartes, 75908 Paris cedex 15, France
| | - M Riquet
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
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30
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Phrenic Nerve Injury During Cardiac Surgery: Mechanisms, Management and Prevention. Heart Lung Circ 2013; 22:895-902. [DOI: 10.1016/j.hlc.2013.06.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 11/17/2022]
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Visouli AN, Mpakas A, Zarogoulidis P, Machairiotis N, Stylianaki A, Katsikogiannis N, Tsakiridis K, Courcoutsakis N, Zarogoulidis K. Video assisted thoracoscopic plication of the left hemidiaphragm in symptomatic eventration in adulthood. J Thorac Dis 2013; 4 Suppl 1:6-16. [PMID: 23304437 DOI: 10.3978/j.issn.2072-1439.2012.s001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/22/2012] [Indexed: 11/14/2022]
Abstract
Diaphragmatic eventration is a rare congenital developmental defect of the muscular portion of the diaphragm, which appears attenuated and membranous, maintaining its normal attachments and its anatomical continuity. It has been attributed to abnormal myoblast migration to the septum transversum and the pleuroperitoneal membrane. Eventration can be unilateral or bilateral, partial or complete. It is more common in males, and involves more often the left hemidiaphragm. Eventration results in diaphragmatic elevation (cephalad displacement). Most adults are asymptomatic and the diagnosis is incidentally made by chest radiography. The commonest symptom in the adults is dyspnoea, while orthopnoea, mild hypoxemia, tachypnoea, respiratory alkalosis, palpitations, and non specific gastrointestinal symptoms may be present. Surgery is indicated only in the presence of symptoms. The established surgical treatment is diaphragmatic plication. Various techniques and approaches have been employed. We present a simple surgical technique of a 3-port video assisted thoracoscopic plication of the left hemidiaphragm in the adult.
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32
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Gazala S, Hunt I, Bédard ELR. Diaphragmatic plication offers functional improvement in dyspnoea and better pulmonary function with low morbidity. Interact Cardiovasc Thorac Surg 2012; 15:505-8. [PMID: 22691375 DOI: 10.1093/icvts/ivs238] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was as follows: In adults with unilateral diaphragmatic paralysis, does diaphragmatic plication offer functional improvement in dyspnoea, better pulmonary function tests (PFTs) and return to activity? A total of 126 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, date and country of publication, patient group studied, surgical approach, study type, relevant outcomes and results of these articles are tabulated. Those articles reporting improvement in PFTs following plication, documented this benefit in the following parameters: mean forced vital capacity (range 17-40%), forced expiratory volume at 1 sec (range 21-27%), functional residual capacity (range 20-21%) and total lung capacity (range 16-19%). The percentage of postoperative improvement in shortness of breath as measured by a dyspnoea score was reported to be between 90 and 96% in the thoracotomy group and 100% in the Video Assisted Thoracoscopic Surgery (VATS) group, the dyspnoea score that was used in all the studies was a visual analogue scale between 0 and 10 where 0 is no dyspnoea and 10 is the worst dyspnoea a patient can have. One of the studies reported postoperative normalization in ventilation perfusion scan (VQ) scan parameters when compared with the preoperative mismatch. Complication rate was similar between the two groups, while the mortality rate was 4% in the thoracotomy group and 0% in the VATS group. The total number of patients included in all the studies combined was 161. All reports included in this review are observational studies (one cohort study and the remainder being case series); therefore, the risk of selection, information and publication biases are high and conclusions should be implemented with caution. We conclude that diaphragmatic plication can improve the functional status, shortness of breath and PFTs of patients with unilateral diaphragm paralysis. Patients undergoing a VATS approach appear to have more advantages in objective and subjective measures (including PFTs, dyspnoea score, length of hospital stay and postoperative complications). Further research with high-quality study designs is advised, focussing mainly on the long-term benefits and assessment of health-related quality of life.
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Affiliation(s)
- Sayf Gazala
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
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Kuo HC, Chang CY, Leung JH. Pulmonary sequestration and diaphragmatic eventration in a 6-month-old infant. Pediatr Neonatol 2012; 53:63-7. [PMID: 22348498 DOI: 10.1016/j.pedneo.2011.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 01/21/2011] [Accepted: 01/31/2011] [Indexed: 11/15/2022] Open
Abstract
A congenital pulmonary malformation, such as pulmonary sequestration or congenital cystic adenomatoid malformation, should be suspected in infants with recurrent lower respiratory symptoms or unifocal infiltrations. The possibility of congenital pulmonary malformation associated with additional abnormalities, such as diaphragmatic hernia, is relatively high and can lead to misdiagnosis. We report a case of a 6-month-old girl who presented with relapsing respiratory infection and hematemesis. Computerized axial tomography scan and barium swallowing study were performed, revealing a suspected intralobar pulmonary sequestration associated with sliding gastric hernia. Since the patient's condition was complicated by sliding hernia, pneumonia and pleural effusion, a surgical procedure instead of cardiac catheterization with coil embolization was performed. During surgery, the absence of a sliding gastric hernia but a diaphragmatic eventration was noted. Only a partial portion of the left-side diaphragm was relaxing, making the barium swallowing study difficult to interpret. This case serves as a reminder that if pulmonary sequestration is suspected, a full work-up with a complete set of imaging studies should be ordered for the possible detection of associated gastrointestinal, respiratory and thoracic abnormalities.
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Affiliation(s)
- Hsing-Ching Kuo
- Pediatric Department, Chia-Yi Christian Hospital, Chia Yi City, Taiwan
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Abstract
This article discusses the diaphragm from a surgical perspective. Although it is a relatively simple organ compared with other structures, the diaphragm serves important anatomic and functional roles necessary for proper respiratory function. It is an organ of little irregularity or disease, and easily manipulated in the operating room by those who have a basic understanding of its anatomic details.
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Diaphragm plication for eventration or paralysis: a review of the literature. Ann Thorac Surg 2010; 89:S2146-50. [PMID: 20493999 DOI: 10.1016/j.athoracsur.2010.03.021] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/11/2022]
Abstract
Although etiology and pathology of symptomatic diaphragm paralysis and eventration are distinct, their treatments are the same: to reduce dysfunctional caudal excursion of the diaphragm during inspiration by plication. Minimally invasive diaphragm plication techniques have emerged as equally effective and less morbid alternatives to open plication. This review focuses on the etiology, pathophysiology, diagnosis, and treatment of diaphragmatic eventration or paralysis in adults.
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