Laparoscopic Plication of the Diaphragm in Infants

Abstract

Background and Purpose: Infants with an elevated hemidiaphragm secondary to eventration or paralysis from birth trauma may have significant pulmonary compromise. Many require prolonged ventilation and are difficult to wean. Plication of the diaphragm has been considered a therapeutic adjunct to improve pulmonary function but often necessitates a thoracotomy. This report describes a technique of laparoscopic plication that avoids the morbidity of an open thoracotomy and the limitations imposed by the rib cage in a thoracoscopic approach. Patients and Methods: Three patients aged 8 to 14 weeks who had elevation of the right hemidiaphragm and could not be weaned from the ventilator were referred for plication. The patients' weights ranged from 1.7 to 3.4 kg, and the gestational age at the time of surgery was 38 to 48 weeks. The surgery was performed under general anesthesia using 3-mm instruments and trocars. Results: Two procedures required three trocars and one required five. The operative time ranged from 25 to 60 minutes. This last case also included a fundoplication and button. There were no operative complications. The patients were weaned off their ventilators at 2, 3, and 14 days. Chest radiographs at 1 month showed the repair to be intact. Conclusion: This report demonstrates that laparoscopic plication of the diaphragm is a safe and effective technique. A laparoscopic approach affords excellent visibility and exposure and avoids the limitations of a thoracic approach.