TY - JOUR
T1 - Anterior diaphragmatic plication in mediastinal surgery
T2 - The "reefing the mainsail" technique
AU - Leo, Francesco
AU - Girotti, Paolo
AU - Tavecchio, Luca
AU - Conti, Barbara
AU - Delledonne, Vincenzo
AU - Pastorino, Ugo
PY - 2010/12
Y1 - 2010/12
N2 - Diaphragmatic plication is usually obtained by suturing the entire dome, which can be laborious when an anterior approach is used. The same result can be obtained by anchoring the redundant diaphragm to the anterior costal arch maneuver, which resembles the action of reefing the mainsail on the boom of a sailboat. Radiologic results have been analyzed from a series of 10 consecutive patients who underwent mediastinal surgery with phrenic nerve section. One week after surgery, no patient had an eventrated diaphragm on lateral chest roentgenogram. No lower lobe atelectasis was recorded in the series until discharge. This technique represents an alternative to classic diaphragmatic plication with three main advantages: (1) it does not require suturing of the posterior part of the dome, which can be difficult to reach when an anterior approach (sternotomy or hemi-clamshell) is used; (2) the presence of three sequential steps, which progressively increases diaphragmatic stretching and permits adjusting the tension of the dome; and (3) the possibility of standard plication is not precluded.
AB - Diaphragmatic plication is usually obtained by suturing the entire dome, which can be laborious when an anterior approach is used. The same result can be obtained by anchoring the redundant diaphragm to the anterior costal arch maneuver, which resembles the action of reefing the mainsail on the boom of a sailboat. Radiologic results have been analyzed from a series of 10 consecutive patients who underwent mediastinal surgery with phrenic nerve section. One week after surgery, no patient had an eventrated diaphragm on lateral chest roentgenogram. No lower lobe atelectasis was recorded in the series until discharge. This technique represents an alternative to classic diaphragmatic plication with three main advantages: (1) it does not require suturing of the posterior part of the dome, which can be difficult to reach when an anterior approach (sternotomy or hemi-clamshell) is used; (2) the presence of three sequential steps, which progressively increases diaphragmatic stretching and permits adjusting the tension of the dome; and (3) the possibility of standard plication is not precluded.
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U2 - 10.1016/j.athoracsur.2010.02.043
DO - 10.1016/j.athoracsur.2010.02.043
M3 - Article
C2 - 21095375
AN - SCOPUS:78649423736
VL - 90
SP - 2065
EP - 2067
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 6
ER -