Video-assisted thoracoscopic plication in symptomatic adults with paralytic hemidiaphragm

INTRODUCTION. Flattening of a paralytic hemidiaphragm by plication may alleviate respiratory symptoms. For decades, the operation was performed through a thoracotomy that caused substantial morbidity, but now minimally invasive video-assisted thoracoscopic approaches are available. We technically modified the procedure using CO₂ insufflation and pledged sutures and aimed to investigate changes in lung function and satisfaction rates in adult patients with hemidiaphragmatic paralysis. METHODS. We retrospectively searched the electronic patient record system for pre-and post-operative pulmonary function tests and satisfaction rates at clinical follow-up. RESULTS. During a three-year period (2021-2023), 15 patients were operated on at a median age of 58 years. Pulmonary function tests improved significantly after diaphragmatic plication (p < 0.01), and nine of 12 patients with available data reported symptomatic improvement (p = 0.02). The median length of hospital stay was one day. CONCLUSIONS. Minimally invasive diaphragmatic plication improves pulmonary function and respiratory symptoms in patients with hemidiaphragmatic paralysis.