Abstract
Diaphragmatic paralysis results from a unilateral or bilateral interruption along the neuromuscular axis manifesting with dyspnea. This chapter focuses on unilateral paralysis and surgical plication as treatment. Plication in symptomatic patients is the preferred surgical intervention with a variety of surgical approaches including open or minimally invasive via chest or abdominal access. All surgical approaches are acceptable and should be tailored to the patient’s anatomy and findings as well as the surgeon’s level of expertise and preference. Overall, a minimally invasive approach is recommended to reduce pain and hospital length of stay.