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Diaphragm Conditions

Diaphragm Surgery
Plication, Hernia & Endometriosis, London

Diaphragmatic plication for paralysis, hernia repair, and surgical management of diaphragmatic endometriosis. Breathlessness markedly worse when lying flat or swimming is a key sign of diaphragmatic weakness — a frequently missed diagnosis. Keyhole surgery with rapid recovery. Breathlessness symptom page →

Last reviewed: April 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382

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Key symptom

Breathlessness markedly worse lying flat, bending forward, or during swimming — a pattern frequently missed for months or years

Common causes

Phrenic nerve injury after cardiac surgery, chest trauma, lung cancer, viral illness — leading to diaphragmatic paralysis and a raised hemidiaphragm

Treatment

Keyhole diaphragmatic plication — surgically tightening the weakened diaphragm. Significant improvement in breathlessness in the majority of patients

About the Condition

Diaphragmatic Paralysis
& Weakness

The diaphragm accounts for approximately 70% of the work of breathing at rest. When the diaphragm is paralysed or weakened — most commonly from phrenic nerve injury after cardiac surgery, thoracic trauma, lung cancer, or infection — the resulting breathlessness can be severe and debilitating.

A key diagnostic feature is breathlessness that is markedly worse when lying flat, bending forward, or during swimming — because in these positions, the abdominal contents rise against the weakened diaphragm, further restricting its movement. These symptoms are frequently attributed to cardiac or respiratory causes for months or years before the correct diagnosis is reached. Breathlessness symptom page →

Key Symptoms of Diaphragmatic Weakness
  • →Breathlessness significantly worse when lying flat
  • →Breathlessness when bending forward
  • →Inability to swim or float on your back
  • →Reduced exercise tolerance with no clear cardiac or airway cause
  • →Elevated hemidiaphragm on chest X-ray
  • →Prior cardiac surgery, chest trauma, or lung cancer
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Diaphragmatic Plication

Plication is a keyhole surgical procedure that tightens and fixes the weakened or paralysed diaphragm in a functional, tensioned position. By restoring mechanical function, plication significantly reduces breathlessness in the majority of patients. The operation is performed under general anaesthesia with a hospital stay of one to three days.

Diaphragmatic Hernia

A diaphragmatic hernia occurs when abdominal contents herniate through a defect in the diaphragm into the chest cavity. This can cause breathlessness, chest discomfort, and gastrointestinal symptoms. Surgical repair is performed keyhole where possible.

Diaphragmatic Endometriosis

Endometriosis can affect the diaphragm, causing cyclical chest pain and shoulder pain related to the menstrual cycle. Specialist surgical management is required. Thoracic endometriosis page → · Cyclical chest symptoms →

Frequently Asked Questions

Questions About
Diaphragm Surgery

Below are the questions patients most commonly ask about diaphragmatic conditions and surgery. See also the breathlessness symptom page →

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Or call Jo Mitchelson:
020 7952 2882

How does diaphragmatic plication improve breathlessness?
By surgically tightening and fixing the weakened diaphragm, plication prevents the abnormal upward movement during breathing. This restores normal chest mechanics and allows the lung on the affected side to expand more fully. Most patients notice a meaningful improvement in breathlessness and exercise capacity within weeks of surgery.
Is diaphragmatic plication major surgery?
Plication is performed using a minimally invasive keyhole technique under general anaesthesia. Hospital stay is typically one to three days. Recovery is significantly faster than with open surgery. It does require a general anaesthetic and specialist thoracic expertise.
My breathlessness came on after heart surgery — could this be my diaphragm?
Yes. Phrenic nerve injury is a recognised complication of cardiac surgery and can cause diaphragmatic paralysis. If you have developed unexplained breathlessness following cardiac surgery — particularly if it is worse lying flat — a diaphragmatic cause should be investigated. Please book a consultation for a specialist assessment.
What investigations are needed before diaphragm surgery?
Assessment typically includes a chest X-ray, CT scan, pulmonary function tests, and a sniff test and ultrasound assessment of diaphragmatic movement. These can usually be arranged promptly at central London locations. All results are reviewed before any recommendation about surgery is made.

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Appointments within 2–3 days. Self-referrals welcome.

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Jo Mitchelson, Private PA  · 020 7952 2882 · pa@lungsurgeon.co.uk

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