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Wang W, Long W, Chen C. [Experience with Wang procedure for treatment of pectus excavatum in young children]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:249-252. [PMID: 30890516 DOI: 10.12122/j.issn.1673-4254.2019.02.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review the experience with Wang procedure for treatment of pectus excavatum in young children. METHODS The clinical data of 21 children with a mean age of 3.3 ± 1.1 years (ranging from 1.5-6 years) undergoing Wang procedure for pectus excavatum were analyzed. A longitudinal incision (1 to 2 cm) was made in the front of the xiphoid, and two tunnels were created using steel bars beneath the muscles on two sides of the chest wall. The fibrous tissue between the diaphragm and the sternum was dissociated, and the steel wires were sutured through the deformed chest wall. After the steel bar was placed in the tunnels, the wires were pulled and fixed in the middle of the bar, and the incision was sutured. RESULTS All the operations were performed using 3 wires and 1 steel bar. The operation time was 25 to 51 (38.1 ± 9.6) min with an intraoperative bleeding volume of 5 to 10 (7.1±1.5) mL. The time of hospitalization of the patients ranged from 6 to 10 days (mean 8.1±1.3 days). In all the patients, the incision healed smoothly without serious pain or obvious complications. All the patients were followed up for 1 to 13 months after the operation. During the follow- up, no recess recurred and no such complications as bar displacement or transposition occurred. According to the evaluation criteria after pectus excavatum operation, 13 cases had a total score of 9, and 8 had a total score of 8. The overall effect was satisfactory, and there were no cases rated as basically satisfactory or unsatisfactory. CONCLUSIONS Wang procedure is a good option for treatment of pectus excavatum in young children.
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Affiliation(s)
- Wenlin Wang
- Department of Chest Wall Surgery, Guangdong Second General Provincial Hospital, Guangzhou 510317, China
| | - Weiguang Long
- Department of Chest Wall Surgery, Guangdong Second General Provincial Hospital, Guangzhou 510317, China
| | - Chunmei Chen
- Department of Chest Wall Surgery, Guangdong Second General Provincial Hospital, Guangzhou 510317, China
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Tedde ML, Togoro SY, Eisinger RS, Okumura EM, Fernandes A, Pêgo-Fernandes PM, Campos JRMD. Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments. ACTA ACUST UNITED AC 2019; 45:e20170373. [PMID: 30758428 PMCID: PMC6534412 DOI: 10.1590/1806-3713/e20170373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. METHODS This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. RESULTS Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. CONCLUSIONS In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.
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Affiliation(s)
- Miguel Lia Tedde
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Silvia Yukari Togoro
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | | | - Erica Mie Okumura
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Angelo Fernandes
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Paulo Manuel Pêgo-Fernandes
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
| | - Jose Ribas Milanez de Campos
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP - São Paulo (SP) Brasil
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St-Louis E, Miao J, Emil S, Baird R, Bettolli M, Montpetit K, Goyette J, Laberge JM. Vacuum bell treatment of pectus excavatum: An early North American experience. J Pediatr Surg 2019; 54:194-199. [PMID: 30414687 DOI: 10.1016/j.jpedsurg.2018.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Conservative treatment of pectus excavatum with a vacuum bell device may be an attractive alternative to surgical repair. We describe an early North American experience with this device. METHODS Prospectively maintained chest wall clinic registries from two institutions were reviewed to identify pectus excavatum patients ≤21 years treated with the vacuum bell from 2013 to 2017. Multivariate linear regression was used to compare mean improvements in deformity-depth and Haller Index between groups of patients based on age and usage metrics (hours/day and days/week). RESULTS Thirty-one patients with a median age of 14 years received treatment with the device. Mean follow-up duration was 18 months. Median depth and Haller Index at treatment onset were 2.3 cm and 3.9, respectively. Improvements in deformity-depth were superior with device usage >2 h/day (p < 0.01) and daily use (p < 0.01). After adjusting for compliance, younger age of treatment onset was associated with greater improvement in Haller Index but not deformity depth. CONCLUSION Our prospective early North American experience found the vacuum bell to be a potential alternative to surgical treatment for pectus excavatum. Longer usage periods in a daily frequency are associated with best results. TYPE OF STUDY Treatment study; case series with no comparison group. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Etienne St-Louis
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Jingru Miao
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Marcos Bettolli
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa
| | - Kathleen Montpetit
- Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Jade Goyette
- Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Jean-Martin Laberge
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada.
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Cohen NS, Goretsky MJ, Obermeyer RJ. Bleeding at Removal of Nuss Bar: Rare But Sometimes Significant. J Laparoendosc Adv Surg Tech A 2018; 28:1393-1396. [DOI: 10.1089/lap.2018.0175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nina S. Cohen
- Departments of Pediatrics and Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Michael J. Goretsky
- Departments of Pediatrics and Surgery, Eastern Virginia Medical School, Norfolk, Virginia
- Department of Pediatric Surgery, Children's Hospital of The King's Daughters, Norfolk, Virginia
| | - Robert J. Obermeyer
- Departments of Pediatrics and Surgery, Eastern Virginia Medical School, Norfolk, Virginia
- Department of Pediatric Surgery, Children's Hospital of The King's Daughters, Norfolk, Virginia
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König TT, Muensterer OJ. Schnappschüsse aus der kinderchirurgischen Sprechstunde – klinische Diagnosen von Kopf bis Fuß. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schulz-Drost S, Luber AM, Simon K, Schulz-Drost M, Syed J, Carbon RT, Besendörfer M. Elastic stable chest repair and its hybrid variants in 86 patients with pectus excavatum. J Thorac Dis 2018; 10:5736-5746. [PMID: 30505481 DOI: 10.21037/jtd.2018.09.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Complex and mature funnel chest deformities are traditionally managed with open surgical procedures. Elastic stable chest repair (ESCR) has been used successfully and safely for relapse corrections. Does pure plate osteosynthesis in ESCR allow comparable corrective potency and implant safety as hybrid methods with metal bars? Methods Data from 86 patients with open funnel chest correction between 2011 and 2015 were analyzed in this retrospective study. Exclusion criteria included being under 12 years of age, and having a history of septic wound healing disorder or other malignant diseases. Main groups consisted of ESCR and hybrid techniques, subgroups were primary and recurrence correction. Correction results and follow-up examinations at six and 12 weeks and at 1 year were statistically analyzed. Results A total of 38 ESCR and 48 hybrid methods were analyzed. Bar implantation was required in 77% (recurrence 34%) of patients. All patients received plates with different combinations e.g., longitudinal-sternal, costosternal and costo-sterno-costal. In all groups, follow-up uptake showed a funnel chest correction result at the anatomical level with healthy values according to the Haller index (ESCR 4.36-2.84, hybrid 6.99-2.74, P<0.001). No material dislocations were observed in any subgroup. Conclusions ESCR and hybrid techniques represent promising and safe therapeutic approaches.
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Affiliation(s)
- Stefan Schulz-Drost
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany.,Department of Trauma and Orthopedic Surgery, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Anna Maria Luber
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Kirsten Simon
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Melanie Schulz-Drost
- Department of Medical Controlling and Management, Military Hospital, Berlin, Germany
| | - Julia Syed
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Roman T Carbon
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Manuel Besendörfer
- Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany
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Factors determining the complications in Nuss procedure. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:621-625. [PMID: 32082805 DOI: 10.5606/tgkdc.dergisi.2018.15707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/21/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to share our experiences in complications developing in patients who underwent Nuss procedure and the management of these complications. Methods In the study, files of 59 patients (50 males, 9 females; mean age 17.6±5.1 years; range, 2.5 to 33 years) who were applied Nuss procedure for pectus excavatum in our clinic between July 2007 and May 2016 were retrospectively assessed. Patients" age, gender, surgical method-complications and hospitalization durations were recorded. Fisher"s chisquare test and logistic regression analysis were used for data evaluation. Results Nuss procedure was performed in all patients without severe complications such as death, organ injury or massive hemorrhage. The most frequently observed postoperative earlyperiod complication was minimal pneumothorax (n=16, 27.1%), while bar dislocation was most frequently observed in the lateperiod (n=5, 8.3%). Conclusion Being male and/or over 23 years of age were determined as risk factors for complication development after Nuss procedure. Still, being a minimally invasive and manageable approach with its success in correcting the deformity, short operation duration, and low complication rates, Nuss procedure can be safely performed in selected patients.
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Weiss HR, Seibel S. Hemidystrophic Thorax Mimicking Scoliosis. Open Orthop J 2018; 12:252-260. [PMID: 30123374 PMCID: PMC6062911 DOI: 10.2174/1874325001812010252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background: We regularly use Angle of Trunk Rotation (ATR) measurements for scoliosis screening and also for clinical follow-up of our scoliosis patients under treatment. In some patients, when ATR measurements exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle), a Hemidystrophic Thorax (HDT) is diagnosed. The purpose of this paper was to present a case series of patients with this kind of thoracic deformity because this may be mimicking scoliosis to a significant degree. Materials and Methods: This case series is a consecutive series of patients where the first author detected a hemidystrophic thorax instead of or in combination with scoliosis. A 3D scan of the trunk was made and adjusted to the coordinates in order to achieve an upright orientation of the upper trunk. The scan was scaled in order to determine certain anatomic landmarks, as performed in preparation for bracing. The scan was cut horizontally at the xiphoid level and the plane at this level was analysed visually in order to detect deformations that were different to the typical scoliotic deformations in the horizontal plane. Results: Seven cases were analysed and described in more detail. Conclusion: The condition of HDT may lead to significant rib humps that mimic scoliosis. According to our case series, mild scoliosis can also be associated with HDT. HDT, according to the cases presented in this study, seems to be a relatively benign deformity. Long-term observations are necessary before a final conclusion can be drawn with respect to prognosis.
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Affiliation(s)
- Hans-Rudolf Weiss
- Physical Medicine and Rehabilitation, Chiropractor, Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457, Gensingen, Germany
| | - Sarah Seibel
- Physical Medicine and Rehabilitation, Chiropractor, Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457, Gensingen, Germany
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Goretsky MJ, McGuire MM. Complications associated with the minimally invasive repair of pectus excavatum. Semin Pediatr Surg 2018; 27:151-155. [PMID: 30078485 DOI: 10.1053/j.sempedsurg.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The minimally invasive pectus excavatum repair (Nuss repair) is performed by pediatric general surgeons and pediatric and adult thoracic surgeons around the world. Complications related to pediatric surgical procedures are always a major concern for surgeons and their patients, and as with all surgery, especially pectus surgery, complications can be life-threatening. The purpose of this article is to discuss early and late complications of pectus excavatum surgery and potential preventive strategies to minimize them.
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Affiliation(s)
- Michael J Goretsky
- Children's Hospital of the Kings Daughters, Division of Pediatric General and Thoracic Surgery, 601 Children's Lane, Norfolk, VA 23507.
| | - Margaret M McGuire
- Children's Hospital of the Kings Daughters, Division of Pediatric General and Thoracic Surgery, 601 Children's Lane, Norfolk, VA 23507
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De Wolf J, Brian E, Wurtz A. Letter to the Editor. J Pediatr Surg 2018; 53:857-858. [PMID: 29366505 DOI: 10.1016/j.jpedsurg.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/17/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Julien De Wolf
- CHU Lille, Department of Thoracic Surgery, F-59000 Lille, France
| | | | - Alain Wurtz
- CHU Lille, Department of Thoracic Surgery, F-59000 Lille, France.
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Dore M, Triana Junco P, De La Torre C, Vilanova-Sánchez A, Bret M, Gonzalez G, Nuñez Cerezo V, Jimenez Gomez J, Luis Encinas J, Hernandez F, Martínez Martínez L, Lopez Santamaria M. Nuss Procedure for a Patient with Negative Haller Index. European J Pediatr Surg Rep 2018; 6:e18-e22. [PMID: 29473012 PMCID: PMC5820059 DOI: 10.1055/s-0038-1623537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/14/2017] [Indexed: 10/29/2022] Open
Abstract
Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed. All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.
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Affiliation(s)
- Mariela Dore
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Paloma Triana Junco
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Carlos De La Torre
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | | | - Monserrat Bret
- Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Gaspar Gonzalez
- Department of Pediatric Traumatology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Vanesa Nuñez Cerezo
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Javier Jimenez Gomez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jose Luis Encinas
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Francisco Hernandez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
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Lung Middle Lobe Laceration Needing Lobectomy as Complication of Nuss Bar Removal. Case Rep Orthop 2018; 2018:8965641. [PMID: 29682380 PMCID: PMC5842718 DOI: 10.1155/2018/8965641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/03/2018] [Accepted: 01/24/2018] [Indexed: 11/18/2022] Open
Abstract
Minimally invasive procedure for the treatment of pectus excavatum as described by Nuss has been used from 1987. The bar initially introduced blindly is now introduced under thoracoscopic control to increase safety of the procedure. It is usually removed two to three years after its insertion in a one-day procedure. Complications of the bar removal are rare but potentially serious. We report the case of a serious complication which occurred immediately after the Nuss bar removal. A 15-year-old boy underwent a Nuss procedure for a severe pectus excavatum without relevant complication. The bar has been removed two years after its insertion in a minimally invasive procedure. Unfortunately, he developed in the immediate postoperative period a hemopneumothorax due to a right middle lobe laceration which required a middle lobectomy by thoracotomy for hemostasis. Lesions of intrathoracic organs are a rare but potentially serious complication of the removal of the Nuss bar. We now propose to perform this procedure under thoracoscopic control to avoid it. In our experience, adhesions between the bar and the pleura are always present, and those with potential risk for bleeding or inducing intrathoracic organ lesions are suppressed prior to the bar removal.
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