1
|
Ersöz H, Karaali R, Kuzmichev V, Rebhandl W, Abu-Akar F, Lakranbi M, Yüksel M. Evaluation of cross-bar and parallel-bar techniques in MIRPE surgery in different countries: a multicenter study. Updates Surg 2024; 76:1501-1509. [PMID: 38097827 DOI: 10.1007/s13304-023-01720-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/29/2023] [Indexed: 08/24/2024]
Abstract
Parallel- and cross-bar techniques are surgical methods used in the pectus excavatum. While the parallel bar is used in many centers, the cross bar is a new technique. The aim of the study is to evaluate the data of centers using cross bar and parallel bar. The aim of this multicenter study is to retrospectively evaluate the data of centers have been using both cross-bar and parallel-bar techniques. 213 parallel bars and 205 cross bars were used. Parallel-bar advantages: the mean patient satisfaction score was 9.40 ± 0.95. Cross-bar advantages: the rate of patients with symmetric deformity was 75.6%, recurrence 0.5%. The mean patient satisfaction score was 9.40 ± 0.95 in operations performed with the parallel-bar technique and 9.13 ± 1.11 in operations performed with the cross-bar technique (p < 0.05). Recurrence was observed in 3.3% of patients undergoing surgery using the parallel-bar technique and 0.5% of patients undergoing surgery using the cross-bar technique (p < 0.04). The cross-bar technique is more advantageous in terms of the recurrence, while second, the parallel-bar technique is associated with greater patient satisfaction. Comparison of data from different countries reveals the differences between patients who have been treated with minimally invasive repair of pectus excavatum and the outcomes of surgery.
Collapse
Affiliation(s)
- Hasan Ersöz
- Department of Thoracic Surgery, Faculty of Medicine, İzmir Katip Çelebi University, İzmir, Turkey.
| | - Rezan Karaali
- Department of Emergency, Faculty of Medicine, İzmir Demokrasi University, İzmir, Turkey
| | - Vladimir Kuzmichev
- Department of Thoracic Surgery, Moscow Regional Clinical Institute (MONIKI), Moscow, Russia
| | - Winfried Rebhandl
- Department of Pediatric Surgery, General Hospital of Vienna-AKH-Wien, Medical University of Vienna, Vienna, Austria
| | - Firas Abu-Akar
- Head of Thoracic Surgery Unit Edith Wolfson Medical Center Halockamim 62 Holon, Tel Aviv, Israel
| | - Marouane Lakranbi
- Department of Thoracic Surgery, Fes University Sidi Mohammed Ben Abdellah, Fes, Morocco
| | - Mustafa Yüksel
- Department of Thoracic Surgery, Emeritus Prof of Marmara University Lecturer of TC Demiroğlu Bilim University Medical School, Istanbul, Turkey
| |
Collapse
|
2
|
Şirazi S, Heydar AM, Bezer M, Yüksel M. Correlation of anterior chest wall anomalies and spinal deformities: a comprehensive descriptive study. Spine Deform 2024:10.1007/s43390-024-00918-8. [PMID: 38900408 DOI: 10.1007/s43390-024-00918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To investigate the association and evaluate the characteristics between different types of anterior chest wall and spinal deformities. METHODS A total of 548 patients with anterior chest wall deformities were included in this study. Clinical and radiological examinations were performed to determine spinal deformities. The type and severity of the spinal deformities were evaluated and their relationships with chest wall deformity subtypes were statistically analyzed. RESULTS Spinal deformities were identified in 93 (16.97%) patients. The patients were subdivided into 71 (76.3%) male and 22 (23.7%) female patients. A spinal deformity was detected in 57 (13%) of 418 pectus excavatum (PE) patients, in 23 (19%) of 117 pectus carinatum (PC) patients, and in all patients with mixed pectus deformity (PE + PC), syndromic deformity and rib anomalies. In the PE group, scoliosis, and kyphosis were observed at 57.9 and 31.6%, respectively. In the PC group, these rates were 43.5 and 47.8%, respectively. Idiopathic scoliosis was observed in 42 (77.7%) and constituted the most common scoliosis subgroup. The main thoracic curvature was the most common curve pattern, which was observed in 15 (35.7%) patients with idiopathic scoliosis. CONCLUSIONS Idiopathic scoliosis with main thoracic curvature is the most common deformity in patients with anterior chest wall deformity. Spinal deformities are more common in male patients with chest deformities. Kyphosis is found in a significant number of PE and PC patients. Patients with mixed PE and PC, rib anomalies, and syndromic disease are more likely to have spinal deformities.
Collapse
Affiliation(s)
- Serdar Şirazi
- Private Orthopaedic Office, Mustafa Kemal Paşa, Firuzköy Blv. Kayabaşı Sk. No:1/3 Avcılar, Istanbul, Turkey
| | - Ahmed Majid Heydar
- Memorial Bahçelievler Hospital, Orthopedic and Traumatology Clinic, Bahçelievler Merkez, Adnan Kahveci Blv. No: 227 Bahçelievler, 34180, Istanbul, Turkey.
| | - Murat Bezer
- Marmara University Hospital, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 10 Üst Kaynarca/Pendik, Istanbul, Turkey
| | - Mustafa Yüksel
- Marmara University Hospital, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 10 Üst Kaynarca/Pendik, Istanbul, Turkey
| |
Collapse
|
3
|
Weinhandl AC, Ermerak NO, Yüksel M, Rebhandl W. 'Short Bars Crossed' to Remodel the Entire Chest Wall in Children and Adolescents with Pectus Excavatum. J Pediatr Surg 2024:S0022-3468(24)00350-6. [PMID: 38914508 DOI: 10.1016/j.jpedsurg.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The cross-bar technique of minimally invasive pectus excavatum (PE) correction remains underreported, which is especially true of pediatric patients. We therefore reviewed the experience of a Turkish and an Austrian center. An additional novelty characterizing both pediatric cohorts was the use of short bars. METHODS In a retrospective study, pediatric PE corrections involving 'short bars crossed' were analyzed for complications and intra-/postoperative outcomes. Cases with two or three bars were included, given that a horizontal third bar was placed whenever considered useful for upper-chest elevation. All bars were fitted with a single stabilizer near the surgical entry point. In the Austrian center, intercostal nerve cryoablation was used for pain management. Descriptive statistics are presented. RESULTS Seventy-eight patients ≤18 years old were evaluable at the Turkish (n = 56) and Austrian (n = 22) centers. Total median values were 16.2 (IQR: 15.1-17.4) years for age and 4.60 (IQR: 3.50-6.11) for Haller index. Ten mild or moderate complications (12.8%) were observed, including just one revision requirement due to bar migration (1.28%). Intercostal nerve cryoablation (n = 13) was associated with longer surgical procedures at 150 (IQR: 137-171) versus 80 (IQR: 60-100) minutes but with shorter hospital stays, given an IQR of 3-4 days versus 4-5 days. CONCLUSION 'Short bars crossed'-with a single stabilizer in a ventral position close to the surgical entry point-ensure a wide distribution of forces, protect against bar migration, are safe and effective, and offer stability at an age characterized by growth and physical activity. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Anja C Weinhandl
- University Clinic of Pediatric and Adolescent Surgery, Comprehensive Center for Pediatrics, Medical University of Vienna, Austria
| | - Nezih O Ermerak
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Yüksel
- Department of Thoracic Surgery, Emeritus Prof of Marmara University Lecturer of TC, Demiroglu Bilim University Medical School, Istanbul, Turkey
| | - Winfried Rebhandl
- University Clinic of Pediatric and Adolescent Surgery, Comprehensive Center for Pediatrics, Medical University of Vienna, Austria.
| |
Collapse
|
4
|
Jaroszewski DE, Bostoros P, Farina JM, Botros MM, Aly MR, Peterson M, Lackey J, Pulivarthi KV, Smith B, Craner R, Stearns JD. Evolution of Pain Control for Adult Pectus Excavatum Repair. Ann Thorac Surg 2024; 117:829-837. [PMID: 37279827 DOI: 10.1016/j.athoracsur.2023.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Pain control after minimally invasive repair of pectus excavatum (MIRPE) can be challenging, especially in adult patients undergoing surgical repair. This study reviewed different analgesic modalities used over ≥10 years after pectus repair. METHODS A retrospective analysis was performed of adult patients (≥18 years) who underwent uncomplicated primary MIRPE at a single institution from October 2010 to December 2021. Patients were classified by analgesic modality used: epidural, elastomeric continuous infusion subcutaneous catheters (SC-Caths), and intercostal nerve cryoablation. Comparisons among the 3 groups were performed. RESULTS In total, 729 patients were included (mean age, 30.9 ±10.3 years; 67% male; mean Haller index, 4.9 ±3.0). Patients in the cryoablation group required significantly lower doses of morphine equivalents (P < .001) and had overall the shortest hospital stay (mean, 1.9 ±1.5 days; P < .001) with <17% staying >2 days (vs epidural at 94% and SC-Cath at 48%; P < .001). The cryoablation group had a lower incidence of ileus and constipation (P < .001) but a higher incidence of pleural effusion requiring thoracentesis (P = .024). Mean pain scores among groups were minor (<3), and differences were insignificant. CONCLUSIONS The use of cryoablation in conjunction with enhanced recovery pathways provided significant benefit to our patients undergoing MIRPE compared with previous analgesic modalities. These benefits included a decrease in length of hospital stay, a reduction of in-hospital opioid use, and a lower incidence of opioid-related complications associated with constipation and ileus. Further studies to assess additional potential benefits with long-term follow-up after discharge are warranted.
Collapse
Affiliation(s)
- Dawn E Jaroszewski
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
| | - Peter Bostoros
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Juan M Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Michael M Botros
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mohamed R Aly
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Michelle Peterson
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Jesse Lackey
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Krishna V Pulivarthi
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Bradford Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Ryan Craner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Joshua D Stearns
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| |
Collapse
|
5
|
Han J, Mou Y, Wang D, Xu Q, Wang J. Modified bar bending method of thoracoscopic nuss procedure on pectus excavatum: a retrospective single-center study. BMC Pediatr 2023; 23:109. [PMID: 36882693 PMCID: PMC9990308 DOI: 10.1186/s12887-023-03909-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Pectus excavatum (PE) is the most common disease of chest wall deformity, with an incidence of 1 in 300-400 births. Nuss procedure has proved to be the best surgical treatment method and has been widely used after clinical use for 30 years. We aimed to review the clinical data of pectus excavatum (PE) of thoracoscopic Nuss procedure adopted the Modified bar bending method of the six-point seven-section type, and compare it with the traditional curved bar bending method to explore the clinical application effect. METHODS Forty-six cases of clinical data were summarized of children with PE who adopted the treatment of the Modified bar bending method of the six-point seven-section type from January 2019 to December 2021, and 51 cases were compared of PE children who adopted the treatment of traditional curved bar bending method from January 2016 to December 2018, including the data of age, gender, preoperative symptoms, symmetry, Haller index, operation time, bar bending time, intraoperative bleeding, postoperative complications, bar migration, postoperative effect evaluation, etc. RESULTS: The Procedure duration (P = 0.008), bar bending time (P < 0.001), and duration of postoperative pain (P < 0.001) were reduced significantly, and the incidence of bar migration after surgery was reduced as well by the modified bar bending method. There was no difference compared with traditional Nuss produce, like the incidence of evaluation of postoperative effects (Excellent, P = 0.93; Good, P = 0.80; Medium, P = 1.00; Poor, P = 1.00), bar migration (P = 1.00), postoperative complications (P = 1.00), Clavien- Dindo classification of surgical complications (I = 0.165; II = 1.00; IIIa = 1.00; IIIb = 1.00; VI = 1.00; V = 1.00), operative safety, and operative validity. CONCLUSION Modified bar bending method of the six-point seven-section type, which is a kind of surgical method worth applying and popularizing, and the advantages of minimally procedure duration, bar bending time, and duration of postoperative pain, compared with the traditional bar bending method.
Collapse
Affiliation(s)
- Jichang Han
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yaru Mou
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Dongming Wang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Qiongqian Xu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Jian Wang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China.
| |
Collapse
|
6
|
Yüksel M, Ersöz H. Pushing the boundaries of minimally invasive repair of pectus excavatum: first experience with a 4-bar technique. Interact Cardiovasc Thorac Surg 2022; 35:6692426. [PMID: 36063459 PMCID: PMC9466571 DOI: 10.1093/icvts/ivac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/23/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Several modifications to minimally invasive repair of pectus excavatum have been reported to date. Of these, the use of multiple bars was a major development. At present, there are 2 established techniques: cross-bar and parallel bar placement. We used a combination of both parallel and cross-bar techniques in a 25-year-old male patient with deep, Grand-Canyon type pectus excavatum, placing a total of 4 bars and 4 stabilizers. The patient had no complications during the 7 months of postoperative follow-up. We share this case report as the first experience using this modified technique in the literature.
Collapse
Affiliation(s)
- Mustafa Yüksel
- Department of Thoracic Surgery, Demiroğlu Bilim University Faculty of Medicine , İstanbul, Turkey
| | - Hasan Ersöz
- Department of Thoracic Surgery, İzmir Katip Çelebi University Faculty of Medicine , İzmir, Turkey
| |
Collapse
|
7
|
To cross or not to cross pectus bars: is this already a dilemma? Gen Thorac Cardiovasc Surg 2022; 70:514. [DOI: 10.1007/s11748-022-01806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
|