Guangdong hospital reports complex diaphragm surgery for a patient unable to lie flat for nearly 30 years

Guangdong Provincial People's Hospital reported on October 22 that a team led by general surgeon Hu Shixiong, working with anesthesiology and operating-room nurses, had performed a difficult laparoscopic diaphragm plication on a 61-year-old patient. Severe diaphragmatic eventration had prevented her from sleeping flat for nearly 30 years. She became breathless after even slight activity, and her oxygen saturation fell to as low as 58% when lying down.

The report identifies her by the pseudonym Aunt Chen. For years, she slept sitting up or partly reclined and attributed her symptoms to weight and age, without systematic assessment or standard treatment. Investigations eventually identified the diaphragm disorder. She had also sought care at several hospitals, but surgery had not proceeded because her low oxygen levels made anesthesia too risky.

Hu explained that diaphragmatic eventration differs from a diaphragmatic hernia. In eventration, the diaphragm remains intact but is abnormally thin, weak and lax, with an elevated contour. It compresses the lung and reduces the space available in the chest, restricting ventilation. Symptoms can worsen when lying down; severe cases may cause low blood oxygen. A hernia, by contrast, involves a defect through which abdominal organs enter the chest.

Preoperative assessment confirmed that the patient became cyanotic in her face and limbs when supine and improved only when sitting. Routine induction of anesthesia while lying flat was unsuitable. The anesthesia and nursing teams developed an individualized approach: induce anesthesia while she remained seated, then rapidly lower her and perform urgent tracheal intubation to establish a secure airway and maintain ventilation.

Hu performed the operation with assistance from Wei Lusheng. The already elevated diaphragm was harder to reach because inflating the abdomen for laparoscopy pushed it higher. After careful dissection and exposure, the team folded the loose, raised diaphragm in multiple layers and fixed it with sutures. The aim was to lower the diaphragm, restore chest space and allow the compressed lung to re-expand. Anesthesiologists continuously monitored oxygenation and vital signs throughout.

The hospital reported that the operation was completed successfully. At a subsequent follow-up visit, the patient walked back to the hospital without the previous chest tightness and breathlessness and said she could finally sleep lying down.

Hu noted that this condition can develop insidiously and be mistaken for obesity, age-related heart or lung changes, or ordinary lung disease. In the report, he advised specialist assessment for persistent breathing difficulty when lying down or reduced exercise tolerance, particularly when imaging shows an elevated diaphragm, so that the diagnosis and an individualized treatment plan can be established.

The article also lists the specialists' outpatient sessions. Hu sees patients on Wednesday afternoons at the Dongchuan Hernia Specialist Clinic, room 323. Wei's listed sessions are Tuesday afternoons at the Dongchuan Vascular, Thyroid and Abdominal Wall Hernia Surgery Clinic, room 326, and Thursday mornings at the Hiatal Hernia and Reflux Disease Clinic, room 573.