Imbrication of diaphragm for eventration, transthoracic or transabdominal, paralytic or nonparalytic
CPT4 code
Name of the Procedure:
Imbrication of Diaphragm for Eventration (transthoracic or transabdominal, paralytic or nonparalytic)
Summary
Imbrication of the diaphragm is a surgical procedure used to correct diaphragm eventration, a condition where part of the diaphragm is abnormally elevated. This can be done either through the chest (transthoracic) or abdomen (transabdominal) and can address both paralytic and non-paralytic diaphragm issues.
Purpose
This procedure addresses diaphragm eventration by tightening and supporting the weakened part of the diaphragm. It aims to restore proper diaphragm function, improve lung capacity and ease breathing difficulties associated with the condition.
Indications
- Chronic breathing difficulties
- Diagnosed diaphragm eventration via imaging
- Reduced lung capacity
- Paradoxical chest movements
- Failure of non-surgical treatments
Preparation
- Fasting for at least 8 hours before the procedure
- Medication adjustments as advised by the doctor (e.g., stopping blood thinners)
- Preoperative diagnostic tests such as chest X-rays, CT scans, or MRI to assess the diaphragm
Procedure Description
- Anesthesia is administered to ensure the patient is asleep and pain-free.
- For a transthoracic approach: An incision is made in the chest to access the diaphragm.
- For a transabdominal approach: An incision is made in the abdomen.
- The surgeon folds (imbricates) the weakened area of the diaphragm and sutures it to reinforce the structure.
- Any excess or damaged tissue may be removed.
- The incisions are closed with sutures or staples.
Duration
The procedure typically takes 2 to 3 hours, depending on the complexity.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Thoracic or general surgeon
- Anesthesiologist
- Surgical nurses
- Possibly a respiratory therapist
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs
- Anesthesia-related risks
- Recurrence of eventration
- Prolonged recovery time
Benefits
- Improved lung function
- Easier breathing
- Reduction in respiratory symptoms
- Enhanced quality of life Benefits can be realized within weeks to a few months post-surgery.
Recovery
- Hospital stay of 3 to 7 days for monitoring and initial recovery
- Pain management with medications
- Gradual increase in physical activity
- Follow-up appointments to monitor progress and remove sutures/staples
- Restrictions on heavy lifting and strenuous activities for several weeks
Alternatives
- Non-surgical treatments such as physical therapy or respiratory exercises
- Minimally invasive procedures for mild cases
- Continuous positive airway pressure (CPAP) therapy
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, there may be pain at the incision site, discomfort from chest or abdominal tightness, and the need for pain management. Physical therapy and breathing exercises may be part of the recovery process to ensure optimal diaphragm function and overall recovery.