ArticleJTCVS techniques2025
Diaphragmatic paralysis after cardiac surgery in children: Long-term results of a simple thoracoscopic diaphragmatic plication technique.
Article in JTCVS techniques, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Thoracoscopic treatment of symptomatic diaphragmatic paralysis can be challenging, especially after surgery. We studied the efficacy and safety of a minimally invasive diaphragmatic plication technique. Methods: A retrospective review was conducted on children who underwent thoracoscopic diaphragmatic repair after cardiac surgery between 2011 and 2020. The technique used a 3-mm camera, a 3-mm trocar, and an 18-gauge epidural needle to access the pleural space. The needle was threaded from posterior to anterior through the diaphragm to place nonabsorbable sutures, creating tension. Results: Forty-five patients (28 male, 17 female) were reviewed, with a median age of 39.5 ± 28 days (range, 8 days to 13 years). The median surgical time was 65.97 ± 12.6 minutes. No organ injuries or conversions to thoracotomy occurred. A chest drain was placed in 18 patients, removed after an average of 1.8 ± 1.2 days. Three patients experienced postoperative complications (severe pneumothorax or persistent pleural effusion), requiring additional chest tubes for 3.6 ± 2 days. All patients were extubated after 2.13 ± 2.3 days. After a follow-up of 6 months to 10 years, 4 recurrences (8.8%) were resolved with re-thoracoscopy and 1 thoracotomy. Conclusions: The needle thoracoscopic diaphragmatic plication technique is simple and associated with low recurrence and complication rates. It is considered the technique of choice for newborns and infants, with favorable long-term results.
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