[Analysis of efficacy in diaphragmatic plication with minimally invasive surgery].

Abstract

OBJECTIVE:

Diaphragmatic paralysis may result difficulty for respiratory compromise and extubation. We study the effectiveness of diaphragmatic plication held in its two modalities: videothoracoscopy assisted surgery (VATS) and percutaneous with needle.

MATERIAL AND METHODS:

Retrospective study of diaphragmatic plication performed in our center in the past three years. Review of clinical histories, analyzing the variables: sex and age, etiology and laterality, surgical indications, technique, ventilation support, complications and outcome. Data Analysis with SPSS 18.0.

RESULTS:

From 2009-2012, 24 diaphragmatic plication were realized (7 left, 13 right, 2 bilateral) in 22 children (15 males). The mean age was 10.4 months (2 to 23.1). In 68.1% paralysis was secondary to thoracic surgery. In 12 patients was performed VATS and in 5 percutaneous with needle. Surgical indications were: respiratory distress (69.1%) with intercurrent processes (pneumonia, bronchiolitis, and atelectasis) and failure of extubation in 27.3%. After diaphragmatic plication in 90.9% respiratory symptoms remitted. Extubation was accomplished in all patients, requiring ventilator support for 12-96 hours. Mean hospital stay was 7.5 days (3 to 13.5). There were no complications derived from surgery. There were two recurrences (9.2%) and only one was reoperated (4.6%). The percutaneous technique decreased the required postoperative analgesia and improved cosmetic outcome in 90.9%.

CONCLUSIONS:

The diaphragmatic plication by minimally invasive surgery reduces operative morbidity and facilitates extubation of ventilator-dependent patients with diaphragmatic paralysis. The percutaneous technique improves the cosmetic results and reduces pain after surgery, without finding differences with VATS.

• Authors: Y Martínez-Criado, S Pérez-Bertólez, M Requena, J A Matute-de Cárdenas, J C De Agustín
• Journal: Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica (Cir Pediatr) Vol. 26 Issue 2 Pg. 59-62 (Apr 2013) ISSN: 0214-1221 [Print] Spain
• Vernacular Title: Análisis de efectividad de la plicatura diafragmática mínimamente invasiva.
• PMID: 24228354 (Publication Type: English Abstract, Journal Article)

Topics

• Female
• Humans
• Infant
• Male
• Minimally Invasive Surgical Procedures (methods)
• Needles
• Respiratory Paralysis (surgery)
• Retrospective Studies
• Thoracic Surgery, Video-Assisted