PLICATION OF THE DIAPHRAGM FOR UNILATERAL EVENTRATION OR PARALYSIS

Unilateral diaphragmatic paralysis and eventration have the same appearance and provoke the same disturbances. Diaphragmatic plication is intended to decrease lung compression, to make the thoracic base and mediastinum more stable, and to strengthen the respiratory action of intercostal, perithoracic, and abdominal muscles: 13 infants and children were operated upon, 7 in acute respiratory failure and ventilator-dependent, 4 in chronic respiratory failure; 11 adults were operated upon, 8 with respiratory and 3 with digestive symptoms. Four infants who had been operated upon before the 10th day of life died: 3 from associated diseases and 1 from a lung infection. The 9 survivors have been followed up for a mean period of 6.6 years. All were asymptomatic and the position of the plicated diaphragm was maintained. The 11 adults have been followed up for a mean period of 8.5 years. Nine were asymptomatic; in 1, dyspnea had decreased; in 1, reflux persisted and was surgically cured. In 5 adults, the respiratory tests showed a mean amelioration of 20% of vital capacity and 15% of forced expiratory volume in 1 s. In infants, the prognosis depends on associated malformations and on the condition of the lung. Plication should be performed after 2 weeks on a ventilator. In older children and adults, plication is justified when the anomaly produces symptoms (malignancy excluded). Plication is simple, efficient, and durable, but there is no indication of subsequent diaphragmatic function: its effects on respiratory mechanics are probably indirect.