Diaphragm plication

[kenscott]

Have you had diaphragm plication?
I am 56, was involved in a car crash Jan 2012. Eventually diagnosed as unilateral diaphragm paralysis. Appeared to be recovering, but following heavy flu, recovery died off and went back to almost the start. I live in the UK. The support has been great, I've been assessed, scanned and measured numerous times. Despite having asthma, I was very fit; running marathons and playing regular football (soccer) still to a decent standard. Obviously all that is gone. I am OK walking about but can't run and can get out of breath speaking. The surgeon has lined me up for plication. Naturally I'm cautious. I am aware of the stated benefits, improved capacity etc,. He has outlined some of the dangers; a 5-10% chance of permanent pain caused by any damage to nerves around the ribs during surgery being the most daunting. There seems very little feedback from people who have had it done. Is there any personal experience either way while I still have the power to change the decision? Also has anyone had any effective alternatives? I am very uncertain about how effective it really is, how much pain is involved, what recovery times and processes are like, how (if at all) it affects later life.
Everything I read about Dr Kaufman in NJ seems marvellous and I so wish there was something similar here. I am desperately grateful though that there is not the financial pressures caused by medical costs here. Dare I ask how much such surgery costs in the US?
Thanks everyone, this is rather an isolating and unknown condition, a community such as this is a powerful tool to inform and support.
Ken

[kenscott]

Thankyou very much Dr Tinkelman for your time and thoughtful words. I am eager to read anyone's experience and advice and yours, clearly grounded in experience, were authoritative.
I look forward to reading any further contributions..

[David Tinkelman, M.D.]

I have not had direct personal experience with diaphragm plication but I have had patients who have had this procedure and the majority have had significant improvement in their shortness of breath.

But, here is what I can say with certainty.  You must take the initiative to gather information about the surgeon who will perform the procedure and the institution in which it will be performed.  You should request objective information about this specific surgeon:  his/her experience, not with chest/abdominal surgery in general but his/her experience with this particular type of surgery.  You have a right to ask for and receive data on how many of how many plications has he/she performed, what is the success rate and what criteria were applied to define success.  Having had the surgery with post-op complications is the universal goal but it is not a measure of success.  You should however inquire about the incidence of complications following surgery performed by this individual, their nature, their severity and their impact on the patient’s quality of life and his/her ability to engage in the activities of daily living, including aerobic exercise.   You do not want to exchange one problem for another.  The measures of success should be the absence of complications and the patient’s improvement in functional capacity.  You have a right to information regarding mortality and morbidity.

Success in the proper sense should be defined in terms of the patient’s functional improvement and the continuance of that improvement in exercise tolerance and reduction in shortness of breath with exertion.  It is also reasonable to ask if any previous patients, who have had this procedure performed by this specific surgeon, have expressed a willingness to share their experience with others, either directly person to person or indirectly in the form of written testimonials.

You must be your own advocate.

Good luck