Plication of the diaphragm

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.



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