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.
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.
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.
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.
Endometriosis can affect the diaphragm, causing cyclical chest pain and shoulder pain related to the menstrual cycle — sometimes associated with pneumothorax. Specialist surgical management is required. This is a rare and complex condition requiring thoracic surgical expertise.
Below are the questions patients most commonly ask about diaphragmatic conditions and surgery.
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