Diaphragm plication

What is diaphragm plication?

Diaphragm plication is a surgical procedure performed under general anaesthesia to treat a weakened or paralysed diaphragm. During the operation, the diaphragm is folded and sutured to flatten and tighten it, improving lung expansion and allowing patients to breathe more easily.

Why is it done?

The diaphragm is the main muscle used in breathing. When it is paralysed or weak, one side may sit higher than normal, reducing lung volume and making breathing difficult. Diaphragm plication is indicated when this significantly affects daily life, causes breathlessness, reduces exercise tolerance, or leads to repeated respiratory infections. Surgery is considered when non-surgical measures, such as breathing exercises or non-invasive ventilation, are insufficient.

What does it involve?

The procedure can be performed as an open operation, with a larger incision in the chest, or as a minimally invasive procedure using video-assisted thoracoscopic surgery (VATS). The patient is positioned on their side, and the surgeon carefully folds the diaphragm and secures it with multiple sutures to a flattened position. VATS typically results in smaller scars, less post-operative pain, and a faster recovery, while open surgery may be preferred in complex cases.

Preparation for diaphragm plication

Patients undergo blood tests, chest imaging, and lung function assessments to ensure they are fit for surgery. Your surgeon will review your medical history, medications, and potential anaesthesia risks. You will need to fast before the operation, and the surgical team will discuss the expected outcomes, recovery plan, and possible complications.

Recovery after the procedure

Most patients stay in hospital for two to five days. Pain is managed with prescribed medications, and gentle breathing exercises are encouraged immediately. Physical activity can gradually resume over several weeks. Follow-up imaging and lung function tests help assess improvement. Most patients notice significant relief from breathlessness and better exercise tolerance within a few months.

Alternative treatments

Non-surgical options include non-invasive ventilation to assist breathing, pulmonary rehabilitation to strengthen respiratory muscles, and in select cases, phrenic nerve pacing for nerve injury-related paralysis.

Risks and considerations

Risks include infection, bleeding, anaesthesia complications, and rarely incomplete improvement in breathing. Long-term outcomes are generally excellent, with most patients experiencing significant improvements in lung function and quality of life.