Enrolment criteria for surgical plication in pediatric diaphragmatic eventration: a systematic review of the literature.

PURPOSE: Diaphragmatic eventration (DE) is an uncommon but clinically significant condition in children. Although diaphragmatic plication is widely performed in symptomatic patients, standardized criteria guiding surgical indication remain poorly defined. This review aimed to identify the clinical-radiological parameters most consistently used to select pediatric surgical candidates.

METHODS

We performed a literature search for English-language studies (2000-2025) reporting pediatric DE cases. Studies limited to radiology, genetics, or unrelated diaphragmatic disorders were excluded. Extracted data included demographics, clinical presentation, surgical criteria, approach, and outcomes.

RESULTS

19 studies involving 893 surgically treated pediatric patients were included. Median age was 12 months (mean ± SD: 21.4 ± 28.7), with a male/female ratio of 1.68:1. Symptoms were reported in 18/19 studies (94.7%), with respiratory distress and pulmonary infection as most frequent ones (78.9% each), followed by GI symptoms (21%). Surgical criteria were described in 18/19 (94.7%): unspecified symptomatic patients (57.9%), respiratory distress (31.6%), recurrent infection (31.6%), ventilatory dependence (10.5%), and, in asymptomatic patients, progressive radiological elevation. Minimally-invasive approaches were reported in 52.3%. Postoperative mortality was 1.6% (14/893).

CONCLUSIONS

Respiratory compromise, ventilatory dependence, recurrent infections, progressive radiological elevation are the most reported indications. Evidence remains retrospective and heterogeneous, highlighting the need for standardized, evidence-based criteria.