Elsevier

Surgery

Volume 137, Issue 2, February 2005, Pages 243-245
Surgery

Brief clinical report
Combination of diaphragmatic plication with major abdominal surgery in patients with phrenic nerve palsy

https://doi.org/10.1016/j.surg.2004.05.052Get rights and content

The role of simultaneous prophylactic diaphragmatic plication during major abdominal operations is evaluated. In five patients with a history of phrenic nerve injury, postoperative ventilation requirements and hospital stay were significantly reduced when synchronous diaphragmatic plication was performed, compared with corresponding values obtained during previous abdominal operation without diaphragmatic plication. In addition, diaphragmatic plication was associated with postoperative improvement of respiratory mechanics and blood gas exchange.

Section snippets

Patients and methods

After approval by the Institutional Research Committee, all patient data was retrieved and studied retrospectively. Between 1995 and 2002, five patients with documented diaphragmatic palsy were referred to our center for a major abdominal operation. In the past, at various times after their nerve injury, all patients had undergone abdominal surgery without concurrent repair of the paralyzed hemidiaphragm (first abdominal operation in Table I). Awareness of the postoperative respiratory failure

Results

Values are expressed as medians with range. Postoperative mechanical ventilation requirements and hospital stay after the second abdominal operation and diaphragmatic plication were 0 (0-0,5) days and 8 (6-16) days, respectively, whereas the corresponding values during the first abdominal operation, when diaphragmatic plication was not performed, were 4 (2-21) days and 12 (4-26) days (P < .04). One month after the diaphragmatic plication, forced vital capacity (FVC), forced expiratory volume1

Comment

Unilateral phrenic nerve injury rarely leads to severe respiratory impairment because the adverse consequences caused by the paralyzed hemidiaphragm are compensated by the musculoskeletal elements involved in the biomechanics of respiratory function.1 Nevertheless, the activity of intercostal and other accessory respiratory muscles is inhibited during rapid eye movement sleep, which leads to nocturnal apnea.4 In addition, patients with phrenic nerve injury are at risk for pulmonary

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