Diaphragmatic paralysis after cardiac surgery in children: Long-term results of a simple thoracoscopic diaphragmatic plication technique

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.