Diaphragmatic overlay reconstruction using a bovine pericardial patch (Peri-Guard®): feasibility, safety, and radiographic outcomes.

BACKGROUND: Surgical treatment of symptomatic diaphragmatic paralysis or eventration classically relies on suture plication of the elevated hemidiaphragm. We describe an alternative technique-overlay reconstruction of the diaphragm using a bovine pericardial patch (Peri-Guard®) without formal plication sutures-and report its feasibility, safety, and radiographic outcomes. METHODS: We retrospectively reviewed consecutive patients undergoing diaphragmatic overlay reconstruction with a Peri-Guard® patch at Hannover Medical School between January 2020 and May 2025. Demographic, perioperative, and radiographic data were collected. Diaphragmatic elevation was quantified on chest radiographs using the interdiaphragmatic height difference (IHD) and relative IHD (rIHD). Preoperative and postoperative measurements were compared. RESULTS: Thirteen patients underwent patch-based diaphragmatic overlay reconstruction. Mean age was 60.0 ± 9.3 years, and mean body mass index was 29.4 ± 4.9 kg/m2. Dyspnoea was the predominant symptom (84.6%). Mean operative time was 124.7 ± 31.7 min; all patients were extubated in the operating room, and there was no perioperative mortality. Mean IHD decreased from 7.32 ± 2.94 cm preoperatively to - 0.29 ± 2.24 cm postoperatively (p < 0.001); mean rIHD decreased from 31.22 ± 11.49 to - 1.47 ± 9.42% (p < 0.001). Exploratory analyses found no significant association between BMI and postoperative radiographic outcomes. CONCLUSIONS: In this small retrospective series, patch-based diaphragmatic overlay reconstruction was technically feasible and was associated with marked early radiographic correction of diaphragmatic elevation. Comparative studies against conventional suture plication are needed to determine relative durability and functional benefit.