Plication of the diaphragm is performed for paralysis or eventration of the diaphragm which can result in breathing difficulties.
Diaphragm paralysis is typically due to damage to the phrenic nerve; while eventration is most commonly congenital.
Surgical plication stabilizes the diaphragm to prevent the lungs from ballooning outward during expiration.
to eventration have other congenital disorder such as:
Undescended testicle
Abdominal visceral transposition
Cleft lip and palate
Hypoplastic arch disorder
Patent ductus arteriosus
Ventricular septal defect (VSD)
Coarctation of the aorta
Gastric volvulus
Horseshoe kidney
Surgical repair
The procedure can be performed either open or thoracoscopically.
For open plication of the diaphragm, a thoracotomy is performed below the eighth rib.
The lung is deflated and retracted upward, the weakened area of the diaphragm is then grasped and sutures, are sewn in rows at the edge of the diaphragm along the patient’s rib cage encircling the inside of their chest wall.
Following plication, the height of diaphragm is lowered by 1-2 ribs, for the lungs to inflate properly and prevent abdominal contents from pushing into the chest.
A thoracoscopic diaphragm plication is similar to the open technique.