Traditional diaphragmatic plication (DP) surgery is employed to ameliorate respiratory function in patients with diaphragmatic paralysis, which is rather complicated. This study introduces a modified method of DP. The efficacy of modified diaphragmatic plication (MDP) in preventing, treating, and relieving dyspnea in patients with phrenic nerve resection or injury due to extensive surgical intervention or local tumor invasion will be evaluated.

Inclusion Criteria:

• Preoperative chest X-ray suggesting diaphragmatic eventration, for which therapeutic MDP was performed;
• Mediastinal tumors encircling the phrenic nerve that could not be dissected or phrenic nerve injury occurring during intraoperative dissection, for which prophylactic MDP was performed;
• Diaphragmatic eventration and dyspnea following mediastinal surgery, for which salvage MDP was performed.

Exclusion Criteria:

• Congenital diaphragmatic deformity or diaphragmatic weakness due to poor general nutritional status;
• Morbid obesity with a BMI greater than 35 kg/m2;
• Neuromuscular diseases, including amyotrophic lateral sclerosis and myasthenia gravis;
• A history of upper abdominal surgery; and (5) Diaphragmatic calcification or fibrosis.

patients who underwent mediastinal tumor resection and MDP between 2020 and 2024 at Shanghai General Hospital. All patients underwent plain chest X-ray or computed tomography (CT) scans prior to surgery to confirm diaphragmatic elevation. Each patient was followed for a minimum of six months.