Video-Assisted Thoracoscopic Repair for Eventration of Diaphragm-An Innovative Synergistic approach
EAES Academy. Bhandarwar A. 07/05/22; 363146; P191
Dr. Ajay Bhandarwar
Contributions
Contributions
Abstract
Aim and Background:
Eventration of the diaphragm is an abnormal elevation of the dome of the diaphragm as a result of paralysis or atrophy of varying degrees of muscle fibers. Thoracoscopic repair is one of the emerging modalities of treatment for this relatively rare condition. This study was conducted to compare the single modality suture plication/ single modality endostapler plication with the combined use of endostapler and suture plication via a thoracoscopic approach.
Materials and methods:
The present study was conducted over a period of 6 years including symptomatic adult patients of diaphragmatic eventration. The patients were operated by thoracoscopic approach and plication of the diaphragm was achieved by one of the three approaches- suture plication, plication with endostaplers or a combination of the two. The data was analyzed with respect to operative time, operative blood loss, intra-operative and post-operative complications and recurrence.
Results:
A total of 18 patients were included in the study. All the patients were operated via VATS approach. 2 patients underwent suture plication of the diaphragm with non-absorbable braided suture, 2 patients underwent plication with endostaplers, and 14 underwent combined plication with both suture and staplers. Of the patients who underwent suture plication 50% percent had recurrence and the other 50% had post-operative complication in the form of pneumonia. Of the patients who underwent endostapler plication, only one had post-operative recurrence. The combined approach group of patients had no complications or recurrence in their follow up period. Post-operative computed tomography of 14 patients undergone synergistic approach confirmed the equivalent anatomical alignment of hemidiaphragm and normally placed abdominal viscera. Operative duration was reduced significantly with the usage of endo-staplers. Post-operatively, decreased pain and complications, shorter duration of recovery and hospital-stay, better degree of post-operative lung expansion, relief of symptoms were documented with the synergistic approach.
Conclusion:
Combined use of endostaplers with suture plication via thoracoscopic approach, offers a minimally invasive option to stiffen the diaphragm, increase the hemithorax volume, reduce the recurrence rate and hence offers a better post-operative outcome. The amalgamation of endo-staplers with plication is a better alternative to conventional plication, provides excellent results with reduced complications and nil recurrence. Larger case series needed to validate the results.
Eventration of the diaphragm is an abnormal elevation of the dome of the diaphragm as a result of paralysis or atrophy of varying degrees of muscle fibers. Thoracoscopic repair is one of the emerging modalities of treatment for this relatively rare condition. This study was conducted to compare the single modality suture plication/ single modality endostapler plication with the combined use of endostapler and suture plication via a thoracoscopic approach.
Materials and methods:
The present study was conducted over a period of 6 years including symptomatic adult patients of diaphragmatic eventration. The patients were operated by thoracoscopic approach and plication of the diaphragm was achieved by one of the three approaches- suture plication, plication with endostaplers or a combination of the two. The data was analyzed with respect to operative time, operative blood loss, intra-operative and post-operative complications and recurrence.
Results:
A total of 18 patients were included in the study. All the patients were operated via VATS approach. 2 patients underwent suture plication of the diaphragm with non-absorbable braided suture, 2 patients underwent plication with endostaplers, and 14 underwent combined plication with both suture and staplers. Of the patients who underwent suture plication 50% percent had recurrence and the other 50% had post-operative complication in the form of pneumonia. Of the patients who underwent endostapler plication, only one had post-operative recurrence. The combined approach group of patients had no complications or recurrence in their follow up period. Post-operative computed tomography of 14 patients undergone synergistic approach confirmed the equivalent anatomical alignment of hemidiaphragm and normally placed abdominal viscera. Operative duration was reduced significantly with the usage of endo-staplers. Post-operatively, decreased pain and complications, shorter duration of recovery and hospital-stay, better degree of post-operative lung expansion, relief of symptoms were documented with the synergistic approach.
Conclusion:
Combined use of endostaplers with suture plication via thoracoscopic approach, offers a minimally invasive option to stiffen the diaphragm, increase the hemithorax volume, reduce the recurrence rate and hence offers a better post-operative outcome. The amalgamation of endo-staplers with plication is a better alternative to conventional plication, provides excellent results with reduced complications and nil recurrence. Larger case series needed to validate the results.
Aim and Background:
Eventration of the diaphragm is an abnormal elevation of the dome of the diaphragm as a result of paralysis or atrophy of varying degrees of muscle fibers. Thoracoscopic repair is one of the emerging modalities of treatment for this relatively rare condition. This study was conducted to compare the single modality suture plication/ single modality endostapler plication with the combined use of endostapler and suture plication via a thoracoscopic approach.
Materials and methods:
The present study was conducted over a period of 6 years including symptomatic adult patients of diaphragmatic eventration. The patients were operated by thoracoscopic approach and plication of the diaphragm was achieved by one of the three approaches- suture plication, plication with endostaplers or a combination of the two. The data was analyzed with respect to operative time, operative blood loss, intra-operative and post-operative complications and recurrence.
Results:
A total of 18 patients were included in the study. All the patients were operated via VATS approach. 2 patients underwent suture plication of the diaphragm with non-absorbable braided suture, 2 patients underwent plication with endostaplers, and 14 underwent combined plication with both suture and staplers. Of the patients who underwent suture plication 50% percent had recurrence and the other 50% had post-operative complication in the form of pneumonia. Of the patients who underwent endostapler plication, only one had post-operative recurrence. The combined approach group of patients had no complications or recurrence in their follow up period. Post-operative computed tomography of 14 patients undergone synergistic approach confirmed the equivalent anatomical alignment of hemidiaphragm and normally placed abdominal viscera. Operative duration was reduced significantly with the usage of endo-staplers. Post-operatively, decreased pain and complications, shorter duration of recovery and hospital-stay, better degree of post-operative lung expansion, relief of symptoms were documented with the synergistic approach.
Conclusion:
Combined use of endostaplers with suture plication via thoracoscopic approach, offers a minimally invasive option to stiffen the diaphragm, increase the hemithorax volume, reduce the recurrence rate and hence offers a better post-operative outcome. The amalgamation of endo-staplers with plication is a better alternative to conventional plication, provides excellent results with reduced complications and nil recurrence. Larger case series needed to validate the results.
Eventration of the diaphragm is an abnormal elevation of the dome of the diaphragm as a result of paralysis or atrophy of varying degrees of muscle fibers. Thoracoscopic repair is one of the emerging modalities of treatment for this relatively rare condition. This study was conducted to compare the single modality suture plication/ single modality endostapler plication with the combined use of endostapler and suture plication via a thoracoscopic approach.
Materials and methods:
The present study was conducted over a period of 6 years including symptomatic adult patients of diaphragmatic eventration. The patients were operated by thoracoscopic approach and plication of the diaphragm was achieved by one of the three approaches- suture plication, plication with endostaplers or a combination of the two. The data was analyzed with respect to operative time, operative blood loss, intra-operative and post-operative complications and recurrence.
Results:
A total of 18 patients were included in the study. All the patients were operated via VATS approach. 2 patients underwent suture plication of the diaphragm with non-absorbable braided suture, 2 patients underwent plication with endostaplers, and 14 underwent combined plication with both suture and staplers. Of the patients who underwent suture plication 50% percent had recurrence and the other 50% had post-operative complication in the form of pneumonia. Of the patients who underwent endostapler plication, only one had post-operative recurrence. The combined approach group of patients had no complications or recurrence in their follow up period. Post-operative computed tomography of 14 patients undergone synergistic approach confirmed the equivalent anatomical alignment of hemidiaphragm and normally placed abdominal viscera. Operative duration was reduced significantly with the usage of endo-staplers. Post-operatively, decreased pain and complications, shorter duration of recovery and hospital-stay, better degree of post-operative lung expansion, relief of symptoms were documented with the synergistic approach.
Conclusion:
Combined use of endostaplers with suture plication via thoracoscopic approach, offers a minimally invasive option to stiffen the diaphragm, increase the hemithorax volume, reduce the recurrence rate and hence offers a better post-operative outcome. The amalgamation of endo-staplers with plication is a better alternative to conventional plication, provides excellent results with reduced complications and nil recurrence. Larger case series needed to validate the results.
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