• Hirochika Matsubara, Yoshihiro Miyauchi, Tomofumi Ichihara, Hiroyasu Matsuoka, Tamo Kunimitsu, Tsuyoshi Uchida, Yuichiro Onuki, Norio Hasuda, Noboru Oyachi, Kunio Takano, and Shoji Suzuki.
• Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan.
• Kyobu Geka. 2014 Oct 1; 67 (11): 976-9.

UnlabelledDiaphragm eventration could inhibit the lung development due to compression. Thus diaphragm plication is required for the diaphragm eventration to prevent lung compression causing lung immaturity. However, we sometimes encounter the difficulty in endoscopic plication for fragile diaphragm without damaging it in narrow thoracic space in children. We demonstrate the plication using no-knife automatic suturing device.MethodTwo linear ridges are made using stapler on the flaccid diaphragm without cutting the tissue. Then the created 2 ridges are sutured so that the diaphragm is plicated.BenefitsOnce the stapler was applied to make 2 linear ridges, we easily sutured and gathered them without checking the damage of the intra-abdominal organs. Furthermore, reinforced ridges could be plicated without damaging the fragile diaphragm. We conclude that above described method is preferable for the diaphragm eventration in pediatric patients with fragile diaphragm and limited thoracic space.

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