If you’re reading this, you or someone you love may be facing the frightening reality of diaphragm paralysis or diaphragm eventration.
In this guide, I will discuss the causes of phrenic nerve injury leading to an elevated hemidiaphragm, with consequent symptomatic diaphragm paralysis and shortness of breath (dyspnea).
Your diaphragm is a dome-shaped muscle that sits beneath your lungs and serves as the primary driver of your breathing. When healthy, it contracts and flattens during inhalation, creating space for your lungs to expand. During exhalation, it relaxes and returns to its dome shape, helping push air out of your lungs.
In unilateral diaphragm paralysis (also called diaphragmatic paralysis or eventration), this natural rhythm is disrupted. Instead of moving down as it should, part of the diaphragm moves upward, working against your breathing and creating the exhausting cycle of breathlessness that many patients describe as “feeling like I’m drowning in air.”
Diaphragm plication is a surgical procedure designed to restore the normal position and function of your diaphragm. The word “plication” comes from the Latin word meaning “to fold.” During this procedure, your surgeon carefully folds and secures the weakened or paralysed portion of your diaphragm, creating a tighter, more stable surface that can better support your breathing.
This occurs when the phrenic nerve, which controls your diaphragm, is damaged or cut during cardiac surgery, lung surgery, or due to trauma, infection, or tumours.
A condition in which the diaphragm is weakened or underdeveloped, causing it to balloon upward into the chest cavity. Some patients are born with a dysfunctional diaphragm (congenital eventration).
The condition can affect one side (unilateral diaphragmatic paralysis) or both sides (bilateral diaphragmatic paralysis) of your diaphragm. Unilateral cases are more common and often have better outcomes with diaphragm plication surgery.
Symptomatic patients might be a candidate for diaphragmatic plication if they are experiencing:
Severe symptoms of shortness of breath, especially when lying flat or during physical activity
Chronic fatigue that limits your daily activities
Recurrent pneumonia or respiratory infections
Sleep disturbances due to breathing difficulties
Reduced exercise tolerance affects your quality of life
The severity of your symptoms
How long have you had the condition?
Your overall health and fitness for surgery
Whether conservative treatments have been unsuccessful
The results of pulmonary function tests and imaging studies
Comprehensive medical evaluation, including heart and lung (pulmonary) function tests
Smoking cessation support, if needed, as smoking significantly impacts healing
There are several ways your surgeon can perform diaphragmatic plication:
Thoracotomy (Open Surgery): The traditional approach involves making an incision in the chest wall to access the diaphragm directly. While this requires a larger incision, it provides excellent visualisation and control for complex cases.
Thoracoscopic diaphragm plication (VATS): This minimally invasive approach uses small incisions and a camera to guide the surgery. VATS often results in less pain, shorter hospital stays, and faster recovery.
Robotic diaphragm plication: Robotic-assisted surgery may be used in some instances, offering enhanced precision when performed by experienced surgeons.
Diaphragm plication is a surgical procedure designed to restore the normal position and function of your diaphragm. The word “plication” comes from the Latin word meaning “to fold.” During this procedure, your surgeon carefully folds and secures the weakened or paralysed portion of your diaphragm, creating a tighter, more stable surface that can better support your breathing.
Position you under general anaesthesia
Access your chest cavity through the chosen surgical approach
Identify the weakened or paralysed diaphragm
Create carefully placed folds (plications) in the diaphragm muscle
Secure each fold with a strong, permanent suture
Ensure proper positioning and tension
Place a temporary chest tube to remove air and fluid
Close the incisions
Have questions about the procedure?
Diaphragm plication is a surgical procedure designed to restore the normal position and function of your diaphragm. The word “plication” comes from the Latin word meaning “to fold.” During this procedure, your surgeon carefully folds and secures the weakened or paralysed portion of your diaphragm, creating a tighter, more stable surface that can better support your breathing.
Your hospital stay will typically last 3-7 days, depending on your surgical approach and individual healing.
During this time:
This period is critical for healing and establishing new patterns:
Most patients see continued improvement during this period:
Studies show diaphragmatic plication has high success rates:
80-95% of patients experience significant improvement in breathing
Reduced Breathlessness. Dramatic reduction in shortness of breath during daily activities
Better Exercise Tolerance. Improved exercise tolerance and quality of life
Fewer Infections. Reduced risk of respiratory infections
Better Sleep. Improved sleep quality and more restful nights
More Energy. Enhanced energy levels and vitality
Most patients maintain their breathing improvements for many years after surgery. While the repaired diaphragm may not function exactly like a healthy one, the plication creates a stable platform that significantly improves respiratory mechanics.
A specialist can assess your case and explain your expected outcome.
Studies show diaphragmatic plication has high success rates:
Your surgical team will take every precaution to minimise these risks, and most patients experience uncomplicated recoveries.
Before considering surgery, your medical team may explore other treatment options:
For some patients with phrenic nerve injury, electrical stimulation of the nerve may be an option.
In some cases, managing symptoms without surgery may be the best approach, particularly for patients with significant other health conditions.
The right option depends on your condition — a specialist can guide you.
Before considering surgery, your medical team may explore other treatment options:
It's helpful to choose a thoracic surgeon with regular experience in diaphragmatic procedures.
Ask about their experience with your specific condition.
Inquire about their success rates and complication rates.
Choose a centre with experience in complex thoracic procedures.
Look for hospitals with robust respiratory therapy programs.
Consider centres with dedicated thoracic surgery units.
Ensure access to pulmonologists, respiratory therapists, and rehabilitation specialists.
Look for centres that offer comprehensive pre- and postoperative care.
Consider the availability of support services for patients and families.
Be patient with your recovery – healing takes time.
Follow your medical team's instructions carefully.
Stay active within your limitations.
Communicate openly about your symptoms and concerns.
Join support groups for patients with similar conditions.
Provide emotional support without being overprotective.
Help with practical matters during early recovery.
Encourage adherence to medical recommendations.
Learn about the condition and its treatment to understand the journey better.
Take care of your own emotional needs during this stressful time.
Understanding the financial aspects of your treatment is essential for planning:
Most insurance plans, including Medicare, cover diaphragmatic plication when it’s medically necessary. Work with your healthcare team and insurance company to understand your coverage.
The total cost includes surgeon fees, hospital charges, anaesthesia, and follow-up care. Minimally invasive approaches can lower costs by reducing hospital stays.
Many hospitals offer financial counselling and assistance programs for patients who need help managing medical expenses.
The right option depends on your condition — a specialist can guide you.
Diaphragmatic plication offers real hope for patients struggling with the debilitating effects of diaphragmatic paralysis or eventration. While the decision to have surgery is never easy, for many patients, it represents the path back to a fuller, more active life. Remember that you are not alone in this journey.
Your medical team, family, and fellow patients who have walked this path are all resources for support and encouragement. With proper preparation, skilled surgical care, and committed recovery efforts, most patients find that diaphragmatic plication gives them something invaluable:
the ability to breathe easily again.
The road to recovery requires patience and dedication, but the destination – improved breathing, increased energy, and renewed quality of life – makes the journey worthwhile. Trust your medical team, believe in your body’s ability to heal, and look forward to a brighter, more breathable future.
This information is provided for educational purposes and should not replace consultation with qualified medical professionals. Always discuss your specific situation with your healthcare team to determine the best treatment approach for your individual needs.
Expert answers to common questions about thoracic surgery, recovery and what to expect.
Surgery Type (Minimally Invasive vs. Open Surgery)
The cost for keyhole surgery typically ranges from £15,000 to £40,000, including surgeon fees, anaesthesia, and hospital charges. Robotic-assisted surgery can be more expensive due to the advanced technology involved, with costs ranging from £25,000 to £50,000.
Open surgery, which may require a more extended hospital stay and intensive care unit stay, can cost between £30,000 and £60,000 or more, depending on the complexity of the procedure.
Surgeon's Fees
The surgeon's fees will vary based on their level of expertise and geographic location. Surgeons in urban areas or those with specialised knowledge in thoracic surgery or diaphragmatic disorders may charge more for their services. These fees can range from £5,000 to £15,000, depending on the complexity of the case and the surgeon's experience.
Anaesthesia Fees
Anaesthesia fees are another factor in the procedure's total cost. For general anaesthesia, the price can range from £1,000 to £3,000, depending on the duration of the surgery and the anesthesiologist's fee.
Preoperative and Postoperative Care
Preoperative evaluations (including imaging tests such as X-rays, CT scans, or MRI scans) may add £500 to £3,000 to the total cost of the surgery.
Postoperative care, including follow-up visits, medication, and possible physical therapy, may cost an additional £1,000 to £5,000.
It is an effective treatment for patients with diaphragmatic dysfunction, including diaphragmatic eventration, phrenic nerve paralysis, and diaphragmatic weakness. The procedure is particularly beneficial for patients who experience severe respiratory distress and have not found relief from conservative treatments like ventilatory support or respiratory therapy.
If you are struggling with breathing difficulties due to diaphragmatic dysfunction, consult with a thoracic surgeon or pulmonary specialist to determine whether this type of surgery is the right solution for you. Your healthcare provider will evaluate your overall health, the extent of diaphragmatic dysfunction, and other factors to ensure that the surgery provides the best possible results.
Contact me today to schedule your consultation. Your journey to better health starts with a single phone call.
020 7459 4367
