Long-term results of the double purse-string plication technique in diaphragmatic eventration: Evaluation on chest radiography

Ayse Parlak; Arif Nuri Gurpinar

doi:10.5281/zenodo.19056956

Authors

Ayse Parlak Bursa Uludag University, Faculty of Medicine, Department of Pediatric Surgery, Bursa, Turkey https://orcid.org/0000-0001-7686-2561
Arif Nuri Gurpinar Bursa Uludag University, Faculty of Medicine, Department of Pediatric Surgery, Bursa, Turkey https://orcid.org/0000-0002-7597-4825

DOI:

https://doi.org/10.5281/zenodo.19056956

Keywords:

Double purse-string, Plication technique, Diaphragmatic eventration

Abstract

Objective: We report the long‑term effectiveness of the double purse‑string plication technique by evaluating postoperative chest X-rays.

Materials and methods: We retrospectively reviewed 24 patients diagnosed with diaphragmatic eventration who underwent the double purse-string plication technique between April 2012 and December 2024. Postoperative outcomes and recurrence were evaluated using chest X-rays during a 5-year follow-up period. Postoperative chest radiographs were available for 20 patients and were included in the analysis. The diaphragmatic levels were evaluated by measuring the intercostal distances and the distance between the peaks of the hemidiaphragm and the apex on the chest X-rays, both pre- and postoperatively.

Results: In the 20 patients, the female-to-male ratio was 1:3, and the median age was 12.5 months (range, 6 months to 17 years). The mean duration of follow-up was 4.77± 2.35 years. A significant decrease of approximately 1.8 intercostal space levels was observed in the diaphragm level from the preoperative period to the postoperative 1^st month. In the following years, no significant elevation was observed in the intercostal level of the corrected elevated diaphragm. The median percentage ratio between the normal and corrected diaphragmatic levels showed a progressive decrease over time: 42.26% preoperatively, 12.84% at postoperative 1^st month, 7.99% at postoperative 1^st year, and 4.71% at postoperative 5^th year (p<0.001).A significant decrease in the percentage difference in diaphragm levels between the normal and elevated sides was observed in the 1^st and 5^th years compared to the preoperative measurement. One patient had a recurrence and underwent re-plication (5%). No significant long-term morbidity or mortality was observed.

Conclusion: The double purse-string plication technique offers an effective, durable, and minimally invasive option for the treatment of diaphragmatic eventration. Our long-term data show stable radiological correction and sustained symptomatic improvement.

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