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Comparison of short-term outcomes of video-assisted thoracoscopic (VATS) plication of diaphragmatic eventration - a six-year prospective cohort study

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Abstract

Diaphragmatic eventration is one of the rarest conditions characterized by elevation of the hemidiaphragm while maintaining its normal attachments. In recent years, video-assisted thoracoscopic surgery (VATS) has gained popularity for diaphragmatic surgery. In this study, we share our experience over six years with VATS plication of diaphragmatic eventration. We conducted a prospective study at our institute for six years from April 2016 to March 2021, which included 37 symptomatic patients with diaphragmatic eventration. The sample size reported in this study is one of the largest to date for VATS diaphragmatic plication. Of these, 18 patients underwent combined stapler and suture plication, and 19 patients underwent single modality approach (10—stapled resection, 9—suture alone plication). All patients were followed-up for a minimum of 2 years. Comparative analysis of the combined approach and the single modality approach was performed. The mean operative time was significantly longer with the combined approach (p value < 0.01). However, there was no difference in postoperative pain (p value = 0.50), analgesia requirement (p value = 0.72), or pleural drainage (p value = 0.32) between the two approaches. Although not statistically significant, the combined approach had fewer post-operative complications (p value = 0.32). Besides, the Single modality approach resulted in one recurrence (p value = 0.32) and one mortality (p value = 0.32). VATS diaphragmatic plication using staplers and/or sutures is safe and efficacious in the management of diaphragmatic eventration. Surgeons should consider using both staplers and sutures whenever possible, rather than selecting one over the other.

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Data availability

The data is maintained in a local database, and details are available at request from the corresponding author with masked identifying details.

Abbreviations

ABG:

Arterial blood gas analysis

CT:

Computed tomography

FEV1:

Forced expiratory volume at 1st second

FRC:

Functional residual capacity

FVC:

Forced vital capacity

PFT:

Pulmonary function tests

RCT:

Randomized controlled trial

TLC:

Total lung capacity

VAS:

Visual analogue scale

VATM:

Video-assisted mini thoracotomy

VATS:

Video-assisted thoracoscopic surgery

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Acknowledgements

It is with great gratitude that I acknowledge all my professors, assistant professors, senior residents, junior residents, staff nurses, health care workers and friends at Grant Government Medical College and Sir JJ Group of Hospitals for shaping me into a better surgeon.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, Maharashtra, 400008, India

    G. Balamurugan, Ajay Bhandarwar, Amol Wagh, Girish Bakhshi, Kashif Ansari, Supriya Bhondve, Nikhil Dhimole & Hemant Jawale

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  1. G. Balamurugan
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  2. Ajay Bhandarwar
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Contributions

GB—Writing original draft (lead), Methodology (lead), formal analysis (lead), review and editing (equal). AB—conceptualization (lead), Methodology (supporting) and review (equal). AW—conceptualization (supporting), Methodology (supporting) and review (equal). GB—conceptualization (supporting), Methodology (supporting) and review (equal). KA—Review and editing (equal). SB—Review and editing (equal). ND—Review and editing (equal). HJ—Review and editing (equal).

Corresponding author

Correspondence to G. Balamurugan.

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Conflict of interest

Balamurugan G, Ajay Bhandarwar, Amol Wagh, Girish Bakhshi, Shirish Bhagvat, Bharat Shah, Kashif Ansari, Supriya Bhondve, Nikhil Dhimole and Hemant Jawale have no conflict of interest or financial ties to disclose. Priyank Kothari has presented our early experience in VATS Diaphragmatic plication at the SAGES 2017 annual meeting in Houston, USA. Balamurugan G received ‘Best Post Graduate thesis’ award for our research at the IAGES 2023 annual meeting in Coimbatore, India.

Ethical approval

An institutional ethics committee approval was obtained for this prospective analysis of data. All procedures being performed as a part of the study were part of routine care. This research work is compliant with STROBE guidelines for observational studies.

Informed consent for participation and publication

Prior to surgical intervention, all participating patients have consented to undergo the procedural interventions described as well as the collection of their data and its subsequent analysis and publication.

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Balamurugan, G., Bhandarwar, A., Wagh, A. et al. Comparison of short-term outcomes of video-assisted thoracoscopic (VATS) plication of diaphragmatic eventration - a six-year prospective cohort study. Updates Surg 76, 279–288 (2024). https://doi.org/10.1007/s13304-023-01583-8

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