Dr. Jaydeep H. Palep
Director & HOD
Bariatric and Minimal
Access Surgery
Nanavati Super Speciality
Hospital, Mumbai

Dr. Nidhi Khandelwal
Associate Consultant
Bariatric and Minimal
Access Surgery
Nanavati Super Speciality
Hospital, Mumbai

THE CASE

A 10-year-old girl from rural India was suffering from a branchial cyst for which the patient had undergone surgery. On pre-operative investigations, her chest X-ray revealed a raised left hemidiaphragm, with no obvious diaphragmatic defect. After being operated for the branchial cyst, she was referred to Nanavati Centre for Bariatric and Minimal Access Surgery, for the Eventration of Diaphragm. On investigation, the patient’s height and weight considering the patient’s age was found to be below the 3rd and 10th percentile. There was also a complaint of dyspnea on exertion and poor appetite. Since the patient lived in an area with poor access to medical care and was symptomatic, it was decided to opt for a surgical repair.

THE PROCEDURE

The patient was planned for a Laparoscopic repair. A double lumen endotracheal tube was used in order to prepare for a thoracoscopic approach if required. Decision was made to plicate in two layersthe 1st with continuous stitches of 2-0 Stratafix™, followed by 1-0 Ethibond® interrupted sutures. This plicated the diaphragm adequately and brought it down. The intraoperative period was uneventful, and the patient was extubated successfully.

THE RESULT

Post-operatively, the patient was comfortable with minimal pain and no respiratory distress. 1 month post surgery, a chest X-ray was repeated, which showed normal position of the diaphragm. An increase in her height and weight was also noted. The patient is now between 10th and 25th percentile and between 50th and 75th percentile for her height and weight respectively. Her appetite has also improved and she is free from symptoms of dyspnea.

DISCUSSION

Eventration of Diaphragm is a rare entity, and today with advances in minimal access surgery it can be handled efficiently with minimal or no morbidity.