Modified diaphragmatic plication prevents and rectifies dyspnea with diaphragmatic eventration caused by phrenicotomy or injuries associated with extended mediastinal surgeries

BACKGROUND: Postoperative dyspnea caused by diaphragm eventration due to phrenic nerve injury after extended mediastinal tumor surgery severely affects postoperative recovery. This study describes a modified diaphragmatic plication (MDP) technique utilizing a stapler and evaluates the feasibility of this method in preventing and treating such dyspnea. METHODS: MDP using a cutting stapler consists of four steps: clamping and lifting, depressing and resecting, cutting and verifying, and hemostasis and reinforcement. This modified method serves three purposes: serves as a prophylactic measure against occasional damage to the phrenic nerve; provides therapeutic intervention for patients undergoing phrenicotomy due to tumor invasion; and functions as salvage diaphragmatic plication for patients who have previously experienced damage for medical reasons. The individual characteristics, surgical procedures, and postoperative outcomes of 58 patients who underwent MDP from 2020 to 2024 at our institute were analyzed. The main outcome measures were the success rate and safety of MDP. RESULTS: A total of 512 cases of mediastinal tumor resection were completed by our team from 2020 to 2024. Among these, 58 patients underwent concurrent MDP. Of these, 43 patients received prophylactic MDP due to intraoperative phrenicotomy, 12 underwent therapeutic MDP for preexisting diaphragmatic eventration, and 3 cases received salvage MDP. No MDP-related complications, mortalities, or re-interventions were observed. Regarding efficacy, a significant reduction in dyspnea was noted in 11 of the 12 (92.3%) patients who received therapeutic MDP during postoperative follow-up. Similarly, 42 patients (97.7%) who received prophylactic MDP remained free from postoperative diaphragmatic eventration. Furthermore, three salvage MDP patients with diaphragmatic eventration caused by previous surgery experienced remarkable amelioration of respiratory symptoms. CONCLUSIONS: The MDP method can safely and effectively prevent or rectify dyspnea caused by phrenic nerve injury or resection in patients subjected to extended mediastinal surgery, and the operation is simple and convenient.