• Syed Zahid Ali Shah
  • Shahbaz Ali Khan
  • Amir Bilal
  • Manzoor Ahmad
  • Gul Muhammad
  • Khalid Khan
  • Muhammad Amjad Khan


Background: Eventration of diaphragm is a congenital condition in which there is absence of muscle fibers in the diaphragm while maintaining all the anatomical attachments normally. Surgical treatment is warranted in symptomatic patients so as to reduce the abnormal ascent of diaphragm. The present study was conducted to analyse the perioperative outcome of thoracotomy in adult patients with diaphragmatic eventration. Methods: This descriptive case series was carried out in Cardiothoracic Surgery-Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan. Medical records of patients operated upon for eventration from June 2002 to June 2013 were reviewed. Patients of either gender, above 16 years who were operated for symptomatic eventrtaion were included in study. All the demographic data, presenting complaints, baseline and post-postoperative dyspnea grade, forced expiratory volume at 1 second (FEV1) and forced vital capacity (FVC) were recorded on predesigned pro forma and analysed using SPSS-16. Results: A total of 38 adult patients underwent surgery for diaphragmatic eventration over the past 11 years in our unit out of which 29 (76%) were males and rest of 9 (24%) were females. Mean age of patients was 41.6±13.84 years. In 31 (81.5%) patients left side was involved. Majority of patients had a dyspnea grade-3 on presentation. Preoperative dyspnoea score (MRC), FEV1 and FVC values were 2.6±0.73, 63.5±13.3 and 67.2±14.6 respectively. Pre-operative and 6-months follow-up values of dyspnoea grade, FEV1 and FVC values showed statistically significant improvement. Conclusion: Our study showed that adult patients with symptomatic unilateral eventration of diaphragm significantly benefit from diaphragmmatic plication.Keywords: Eventration, diaphragm, thoracotomy, Dyspnea score, FEV1, FVC


Groth SS, Andrade RS. Diaphragm Plication for Eventration or Paralysis: A Review of the Literature. Ann Thorac Surg 2010;89:2146–50

Mouroux J, Venissac N, Leo F, Alifano M, Guillot F. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study. Ann Thorac Surg 2005;79:308–12.

Calvinho P, Bastos C, Bernardo JE, Eugénio L, Antunes MJ. Diaphragmmatic eventration: long-term follow-up and results of open-chest plicature. Eur J Cardiothorac Surg 2009;36:883–7.

Ribet M, Linder JL. Plication of the diaphragm for unilateral eventration or paralysis. Eur J Cardiothorac Surg 1992;6(7):357–60

Deslauriers J. Eventration of the diaphragm. Chest Surg Clin North Am 1998;8:315–30.

Obara H, Hoshina H, Iwai S, Ito H, Hisano K. Eventration of the diaphragm in infants and children. Acta Paediatr Scand 1987;76:654–8.

Petit, J. L. Trait& rlrr Maladies Chirzirgicales rt der Ope'l-ations Qui Lfwr Convifvment: Owl-age Posthzime de J. L. Petit (Revised ed.). Lesne, 17'30. Vol. 11, p. 233.

Beclard, E. Cited by J. Cruveilhier in Atlas d’dnatomie Pathologique. Pari5: 1829. Vol. I, book 17, plate V, p. 2.

Morrison JMW. Eventration of diaphragm due to unilateral phrenic nerve paralysis. Arch Radiol Electrotherap 1923;28:72–5.

Chin EF, Lynn RB. Surgery of eventration of the diaphragm. J Thorac Surg 1956;32:6–14.

Piehler JM, Pairolero PC, Gracey DR, Bematz PE. Unexplained diaphragmatic paralysis: a harbinger of malignant disease? J Thorac Cardiovasc Surg 1982;84:861-4

Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I. Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis. J Cardiothorac Surg 2010;5:111

Groth SS, Rueth NM, Kast T, D'Cunha J, Kelly RF, Maddaus MA, et al. Laparoscopic diaphragm plication for diaphragmatic paralysis and eventration: an objective evaluation of short- and mid-term results. J Thorac Cardiovasc Surg 2010;139:1452–6.

Shields TW. Diaphragmatic function, diaphragmatic paralysis, and eventration of the diaphragm. In: Shields TW, Locicero III J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. Lippincot Williams & Wilkins; 2005 . p. 740–5.

Brara BS, Rossiter M, Moore KA. Eventration of Diaphragm with Volvulus of Stomach and Extralobar Sequestration of the Lung. Proc R Soc Med 1977;70(10):725–6.

Mitchell TE, Ridley PD, Forrester-Wood CP. Spontaneous rupture of a congenital diaphragmatic eventration. Eur J Cardio-thorac Surg 1994;8:281–2.

Watanabe S, Shimokawa S, Fukueda M, Kinjyo T, Taira A. Large Eventration of Diaphragm in an Elderly Patient Treated With Emergency Plication. Ann Thorac Surg 1998;65:1776–7

Kuniyoshi Y, Yamashiro S, Miyagi K, Uezu T, Arakaki K, Koja K. Diaphragmatic plication in adult patients with diaphragm paralysis after cardiac surgery. Ann Thorac Cardiovasc Surg 2004;10:160–6.

Simansky DA, Paley M, Refaely Y, Yellin A. Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients. Thorax 2002;57:613–6.

Higgs SM, Hussain A, Jackson M, Donnelly RJ, Berrisford RG. Long term results of diaphragmatic plication for unilateral diaphragm paralysis. Eur J Cardiothorac Surg 2002;21:294–7.

Versteegh MI, Braun J, Voigt PG, Bosman DB, Stolk J, Rabe KF et al Diaphragm plication in adult patients with diaphragm paralysis leads to longterm improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg 2007;32:449–56.

Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg 2006;81:1853–7.

Di Giorgio A, Cardini CL, Sammartino P, Sibio S, Naticchioni E. Dual-layer sandwich mesh repair in the treatment of major diaphragmatic eventration in an adult. J Thorac Cardiovasc Surg 2006;132:187–9.

Hwang Z, Shin JS, Cho YH, Sun K, Lee IS. A simple technique for the thoracoscopic plication of the diaphragm. Chest 2003;124:376–8.

Moon SW, Wang YP, Kim YW, Shim SB, Jin W. Thoracoscopic plication of diaphragmatic eventration using endostaplers. Ann Thorac Surg 2000;70:299–300.

Freeman RK, Van Woerkom J, Vyverberg A, Ascioti AJ. Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. Ann Thorac Surg 2009;88:1112–7.

Kizilcan F, Tanyel FC, Hicsonmez A, Buyukpamukcu N. The long-term results of diaphragmatic plication. J Pediatr Surg 1993;28:42–4.

Huttl TP, Wichmann MW, Reichart B, Geiger TK, Schildberg FW, Meyer G. Laparoscopic diaphragmatic plication: longterm results of a novel surgical technique for postoperative phrenic nerve palsy. Surg Endosc 2004;18:547–51.

Groth SS, Andrade RS. Diaphragmatic eventration. Thorac Surg Clin 2009;19:511–9.

Mahler DA, Weinberg DH, Wells CK, Feinstein AR. The measurement of dyspnea. Chest 1984;85:751—8.

Pathak S, Page RD: Splenic injury following diaphragmatic plication: an avoidable life-threating complication. Interact Cardiovasc Thorac Surg 2009;9:1045–6.

Phadnis J, Pilling JE, Evans TW, Goldstraw P. Abdominal compartment syndrome: a rare complication of plication of the diaphragm. Ann Thorac Surg 2006;82:334–6.




Most read articles by the same author(s)

1 2 3 4 5 6 7 > >>