P-184LONG-TERM FUNCTIONAL RESULTS AFTER SURGERY FOR DIAPHRAGMATIC EVENTRATION OR RUPTURE: THE RATIONALE OF PROSTHETIC REINFORCEMENT

Abstract

Objectives: To assess pulmonary and diaphragmatic function after diaphragmatic plication reinforced by pericostal fixed mesh for eventration and repair of diaphragmatic hernia through reduction and direct suture. Methods: From 1996 to 2010, 10 patients with unilateral eventration and 6 patients with misunderstood chronic transdiaphragmatic hernia underwent elective surgery. Preoperative and 12 months follow-up assessment included pulmonary function tests, measure of maximum inspiratory pressure in clinoand orthostasis, blood gas analysis, chest-CT scan and dyspnoea score. Results: Patients of the two groups did not differ in terms of preoperative lung function, postoperative complications or in-hospital stay; at follow-up of 12 months, Eventration group showed significant improvement of FEV1% (+18.2 - P < 0.001), FVC% (+12.8 - P < 0.001), DLCO% (+6.84 - P = 0.04) and pO2 (+9.8 mmHg - P < 0.001). Conversely in Hernia group only pO2 gain was significant (+8.3 - P = 0.04). Although maximal inspiratory pressure (MIP) increased in both groups at follow-up, patients operated for hernia showed minor improvement with persistent significant fall of MIP passing from orthostasis to clinostasis (P < 0.001). Transitional dyspnoea score reflected such improvements but no differences were found in gain between the two groups. CT-scan showed a slight elevation of the diaphragm in patients operated for diaphragmatic laceration, even without recurrent hernia, while patients operated for eventration maintained postoperative hypercorrection. Chronic pain was present in 1 patient operated for eventration. Conclusions: The use of prosthetic reinforcement after diaphragmatic surgery is safe and seems to ensure better and more stable results either in terms of pulmonary flows and paradoxical diaphragmatic movement (assessed through maximum inspiratory pressure) in patients operated for eventration. Large diaphragmatic tearings involving main branches of phrenic nerve are likely to cause diaphragm denervation; consequent underlying eventration may therefore impair postoperative functional results at long-term follow-up and could so benefit of prosthetic reinforcement as usual in our Institution for pure eventration.