Surgery for diaphragmatic eventration: Technical aspects by thoracotomy and VATS

The "diaphragmatic eventration" is a condition of relaxation of the diaphragm by maintaining its normal attachments to the dorsolumbar spine, the lower ribs, and the sternum. Diaphragmatic eventration is rare (incidence <0.05%), and more common in males. It can be unilateral or bilateral, but usually left hemidiaphragm is affected. It may be congenital, (due to a defect of diaphragmatic development) or acquired. Macroscopically, the (affected portion of the) diaphragm is attenuated, abundant, membranous, and without muscular appearance. Microscopically there is paucity or absence of muscular fibers and diffuse fibroelastic changes. It can be partial or complete affecting the whole hemidiaphragm. The ‘true’ eventration is always a congenital condition. If the condition is severe, it causes severe cardio-respiratory symptoms secondary to hypoplasia of the lung on the affected site.