The Utility of Paradoxical Motion in Selecting Patients for Diaphragm Plication

The functional consequences of diaphragm eventration vary among patients. Some have almost no respiratory symptoms, while others experience severe disabling discomfort affecting their quality of life. Selecting the right candidates to offer diaphragm plication, an operation aimed at functional improvement, is therefore essential to achieve clinical improvement in highly symptomatic patients. Paradoxical motion detected by the Sniff Test or by diaphragm ultrasound is a criterion traditionally used by some teams to select the right patients. This criterion certainly indicates a destabilization of the entire diaphragm plane, but to date, it cannot be proposed as an absolute criterion to validate the surgical indication. Nevertheless, it is reasonable to hypothesize a link between paradoxical motion and a greater improvement in respiratory symptoms after surgery. Its place in patient selection remains to be defined by future multicentric prospective studies.