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