What type of surgeon performs diaphragm surgery?

Thoracic Surgeons Perform Diaphragm Surgery

Diaphragm surgery is primarily performed by thoracic surgeons, who have specialized training and expertise in managing disorders of the diaphragm and thoracic cavity. 1

Types of Surgeons Who Perform Diaphragm Surgery

• Board-certified thoracic surgeons are the specialists most qualified to perform diaphragm surgery, as thoracic procedures constitute at least 50-75% of their clinical practice 2
• General surgeons may perform diaphragmatic hernia repairs, particularly in emergency settings involving unstable patients with strangulation or perforation 1
• Cardiothoracic surgeons who primarily practice thoracic surgery have better outcomes for thoracic procedures compared to general surgeons 2

Surgical Approaches for Diaphragm Surgery

• For complicated diaphragmatic hernias in unstable patients, an abdominal approach (laparotomy) is typically recommended 2, 1
• In stable patients, minimally invasive approaches (laparoscopic or thoracoscopic) are preferred 1
• For chronic hernias with viscero-pleural adhesions, a thoracic approach (thoracotomy or thoracoscopy) is often necessary, requiring thoracic surgical expertise 2, 1
• Complex cases may require a combined thoraco-abdominal approach with collaboration between surgical specialties 1

Factors Influencing Surgical Approach Selection

• The chronicity of the condition is a primary factor in determining the best surgical approach 1
• Surgeon preferences, skills, and available local resources significantly influence the approach chosen 1
• The size of the diaphragmatic defect affects the repair technique - larger defects (>3 cm) typically require mesh reinforcement 2

Outcomes Based on Surgeon Specialization

• Multiple studies show lower perioperative mortality when thoracic or cardiac surgeons perform thoracic procedures compared to general surgeons 2
• A high-quality meta-analysis demonstrated a pooled odds ratio for perioperative mortality of 0.78 (95% CI, 0.7-0.88) for thoracic surgeons versus general surgeons 2
• Complication rates and length of hospital stay are lower when thoracic and cardiac surgeons perform these procedures 2
• Long-term survival is better after surgery performed by thoracic or cardiac surgeons compared to general surgeons 2

Common Diaphragm Surgical Procedures

• Diaphragmatic hernia repair - typically performed using non-absorbable sutures, with mesh reinforcement for larger defects 2
• Diaphragm plication - performed for diaphragmatic paralysis, often using video-assisted thoracoscopic surgery (VATS) techniques 3
• Diaphragm reconstruction after resection - necessary when portions of the diaphragm are removed due to tumor involvement 4

Special Considerations

• For diaphragmatic hernia repair, biological meshes have lower recurrence rates, higher resistance to infections, and lower risk of displacement compared to synthetic meshes 2
• Thoracic surgeons are more likely to perform mediastinal lymph node dissection and use advanced techniques like VATS compared to general surgeons 2
• Proper understanding of diaphragmatic anatomy, innervation, and blood supply is crucial for successful outcomes in diaphragm surgery 4, 5