What Is a Plication of the Diaphragm Procedure?

What is the diaphragm muscle?

Plication of the diaphragm muscle sutures the organ tightly in position inside the rib cage to treat breathing difficulties. Diaphram malfunction or deformity may result from congenital problems or a malfunctioning phrenic nerve.Plication of the diaphragm muscle sutures the organ tightly in position inside the rib cage to treat breathing difficulties. Diaphram malfunction or deformity may result from congenital problems or a malfunctioning phrenic nerve.

A diaphragm is a primary muscle that helps in respiration (breathing process). This dome-shaped muscle is located just below the lungs and heart. It contracts continually as we breathe in and out. This thin muscle at the chest base separates the abdomen from the chest. It contracts and flattens when we breathe. This creates a vacuum effect that pulls air into the lungs. When you exhale, the diaphragm relaxes, and the air is pushed out of the lungs.

Additionally, it has some nonrespiratory functions. The diaphragm increases abdominal pressure to eliminate vomit, urine and feces from the body. It also places pressure inside the throat to prevent acid reflux.

The phrenic nerve controls the diaphragm movement.

What is a plication of the diaphragm procedure?

A plication of the diaphragm is performed for paralysis or abnormally shaped diaphragm. This condition usually leads to breathing difficulties. Diaphragm paralysis is typically due to damage to the phrenic nerve. Abnormality of the diaphragm may be birth related. Surgical plication to stabilize the diaphragm is needed to prevent the lungs from ballooning outward during expiration (breathing out).

How is a diaphragmatic plication performed?

A diaphragmatic plication can be performed with either an open or thoracoscopic approach. Usually, it is performed under general anesthesia. The procedure takes about two hours. 

For open plication of the diaphragm:

  • The patient is placed lying on their side. A surgical incision is made into the chest wall below the eighth rib. 
  • The lung is deflated and retracted upward. 
  • Any adhesions found are freed.
  • The weakened area of the diaphragm is then grasped with a clamp and elevated to determine the location of the suture line. 
  • Layers of sutures, sometimes reinforced with Teflon pads, are sewn in rows at the edge of the diaphragm along the patient's rib cage encircling the inside of their chest wall.
  • After plication, the height of diaphragm is lowered by one or two ribs, helping the lungs inflate properly and prevent abdominal contents from pushing into the chest.
  • Chest tubes are placed to drain fluid or air that accumulates.

Thoracoscopic diaphragm plication:

  • It is similar to the open technique.
  • Two or three small incisions are made, and ports are placed. In addition, a 5-cm surgical incision into the chest wall may be made.
  • The diaphragm is depressed into the abdomen, and two rows of sutures are sewn into either side of the edge of the diaphragm where it meets the chest wall.
  • The suture is tied in place, creating a crease in the diaphragm that tightens and lowers the diaphragm into the abdomen.

What are the risks involved in the diaphragmatic plication?

The severity of some of these complications is probably a reflection of the severity of comorbid health problems in this patient population. Complications of diaphragmatic plication include: 

  • Prolonged chest tube drainage of higher than seven days 
  • Respiratory failure 
  • Gastrointestinal hemorrhage 
  • Splenic cut requiring splenectomy 
  • Stroke 
  • Abnormal heart rhythm
  • Injury to the heart or its adjoining structure 
  • Injury to the lung and its adjoining structure

How long does it take to recover from a diaphragmatic plication surgery?

Usually, recovery time for a diaphragmatic plication surgery is eight to 12 months. It is common to feel tired for six to eight weeks after the surgery. The chest may hurt and be swollen for up to six weeks.

What is the outcome of diaphragmatic plication?

Successful diaphragmatic plication for birth defects and diaphragm paralysis reduces lung compression and symptoms. It improves the quality of life for the long-term.

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