Specialist Who Treats Diaphragmatic Eventration
Diaphragmatic eventration is primarily managed by pediatric surgeons in children and by general surgeons or thoracic surgeons in adults, with the choice depending on the surgical approach selected and local institutional expertise.
Primary Specialists by Patient Population
Pediatric Patients
- Pediatric surgeons are the primary specialists who manage diaphragmatic eventration in children, performing diaphragmatic plication via either thoracotomy or laparotomy 1, 2, 3
- The surgical approach in children is typically thoracotomy (most common) or laparotomy, both performed by pediatric surgeons 1, 4
Adult Patients
- General surgeons typically manage diaphragmatic eventration in adults, particularly when an abdominal approach is selected 5, 6
- Thoracic surgeons are involved when a thoracic approach (thoracotomy or thoracoscopy) is preferred, especially in cases with chronic viscero-pleural adhesions 5, 6
Factors Determining Specialist Selection
Surgical Approach Considerations
- For abdominal approach (laparotomy): General surgeons are typically the primary operators 5
- For thoracic approach (thoracotomy/thoracoscopy): Thoracic surgeons are often preferred, particularly for chronic cases with pleural adhesions 5
- Minimally invasive approaches (laparoscopic or thoracoscopic) can be performed by either general or thoracic surgeons depending on their expertise and institutional resources 5
Clinical Presentation Impact
- Symptomatic patients with respiratory distress require urgent surgical intervention, typically by whichever specialist (pediatric surgeon in children, general or thoracic surgeon in adults) is most readily available with appropriate expertise 1, 3, 4
- Asymptomatic patients may be managed conservatively without surgery, though some pediatric surgeons advocate for early plication to optimize future lung growth 4
Institutional and Resource Factors
- Local expertise and surgeon preferences significantly influence which specialist manages these cases 5
- Available resources and institutional protocols play important roles in specialist selection 5
- In complex cases requiring combined thoraco-abdominal approaches, collaboration between surgical specialties may be necessary 5
Common Pitfalls and Caveats
Timing of Surgical Referral
- Symptomatic patients should be referred immediately for surgical evaluation, as diaphragmatic plication provides dramatic improvement in respiratory status 1, 4
- Patients requiring mechanical ventilation benefit from early plication, with most able to discontinue ventilatory support within 0-6 days post-operatively 4
Surgical Technique Considerations
- Regardless of specialist, the procedure involves diaphragmatic plication using reefing mattress sutures on pledgets 4
- The plication must be sufficiently tight; inadequate plication may require reoperation 4
Conservative Management Limitations
- While asymptomatic adult patients may be managed conservatively, gradual diaphragmatic rise or relapse of respiratory symptoms can occur even after successful plication 6
- In children, early surgical intervention is generally favored for symptomatic cases due to excellent outcomes and prevention of long-term respiratory compromise 1, 2, 3, 4