Single-center experience with laparoscopic diaphragmatic plication for diaphragmatic eventration

Background: Diaphragmatic eventration is a rare condition characterized by the abnormal elevation of the diaphragm due to muscular deficiency, which impacts respiratory and gastrointestinal functions. Historically, open surgical approaches have been utilized for treatment; however, laparoscopic diaphragmatic plication (LDP) has emerged as a less invasive alternative, offering benefits such as reduced postoperative pain and faster recovery. Methods: This retrospective study included 15 patients with diaphragmatic eventration presenting with respiratory or upper abdominal symptoms. All patients underwent LDP under general anesthesia, which involved diaphragmatic plication and reinforcement with a double-deck complex patch. The primary outcomes assessed were postoperative complications, the descending distance of the diaphragm, symptom improvement, and long-term follow-up to assess recurrence. Secondary outcomes included operative time, blood loss, and postoperative hospital stay. Results: The average age of participants was 66 ± 8 years, with all cases involving left diaphragmatic eventration. The mean surgical duration was 106 ± 4 minutes, and the mean blood loss was 11.5 ± 6.6 ml. Postoperative complications included pleural effusion in seven patients, with four requiring drainage. Diaphragmatic plication effectively lowered the diaphragm by 1.7 ± 0.8 intercostal spaces. Thirteen patients showed significant improvement in symptoms, while one experienced persistent epigastric pain and another ongoing dyspnea. Pulmonary function tests revealed improved percent predicted Forced Vital Capacity (FEV1%) and percent predicted Forced Expiratory Volume in 1 Second (FEV1%) in four out of five patients. During an 8- to 68-month follow-up, one patient experienced symptom recurrence 18 months postoperatively, attributed to chronic constipation causing increased intra-abdominal pressure. Conclusions: LDP is a safe and effective treatment for diaphragmatic eventration, significantly improving respiratory function and symptoms. However, comprehensive preoperative assessment and management of underlying conditions are crucial to prevent recurrence and optimize long-term outcomes. Future studies with larger cohorts and prospective designs are warranted to further evaluate the long-term efficacy of LDP.