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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.
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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.
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Media AS, Christensen TD, Katballe N, Juhl-Olsen P, Vad H, Petersen RH, Højsgaard A, Vincenzo de Paoli F. Complication rates rise with age and Haller index in minimally invasive correction of pectus excavatum: A high-volume, single-center retrospective cohort study. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00107-7. [PMID: 38340954 DOI: 10.1016/j.jtcvs.2024.01.047] [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: 05/05/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The study objectives were to describe the compounded complication rate of minimally invasive repair of pectus excavatum, identify predisposing risk factors, and evaluate the optimal timing of correction. Minimally invasive repair of pectus excavatum is the standard treatment for pectus excavatum and consists of 2 invasive procedures, for example, correction with bar insertion followed by bar removal after 2 to 3 years. METHODS A retrospective cohort study identifying children, adolescents, and adults of both genders corrected for pectus excavatum with minimally invasive repair of pectus excavatum between 2001 and 2022. Information on complications related to bar insertion and removal procedures for each individual patient was compiled into a compounded complication rate. Complication severities were categorized according to the Clavien-Dindo classification. RESULTS A total of 2013 patients were corrected by minimally invasive repair of pectus excavatum with a median age (interquartile range) for correction of 16.6 (5) years. Overall compounded complication rate occurred at a frequency of 16.4%, of which 9.3% required invasive reinterventions (Clavien-Dindo classification ≥IIIa). The complication rate related to bar insertion was 2.6-fold higher compared with bar removal (11.8% vs 4.5%, respectively). Multivariable analysis revealed age (adjusted odds ratio, 1.05; P < .001), precorrection Haller Index (adjusted odds ratio, 1.10; P < .033), and early-phase institutional experience (adjusted odds ratio, 1.59; P < .002) as independent predisposing risk factors. The optimal age of correction was 12 years, and the compounded complication rate correlated exponentially with age with a doubling time of 7.2 years. Complications increased 2.2-fold when the Haller index increased to 5 or more units. CONCLUSIONS Minimally invasive repair of pectus excavatum is associated with a high compounded complication rate that increases exponentially with age and high Haller Index. Consequently, we recommend repair during late childhood and early adolescence, and emphasize the importance of informing patients and relatives about the significant risks of adult correction as well as the need of 2 consecutive procedures taking the complication profile into account before planning surgery.
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Affiliation(s)
- Ara S Media
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Katballe
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Juhl-Olsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Vad
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Anette Højsgaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Frank Vincenzo de Paoli
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark.
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Basic Strategies of Augmentation Mammoplasty in Patients with Tendencies of Pectus Excavatum and Carinatum. Aesthetic Plast Surg 2023; 47:54-60. [PMID: 35922671 DOI: 10.1007/s00266-022-02991-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND In this era of growing popularity of cosmetic surgeries, more women of various chest wall shapes are likely to receive augmentation mammoplasty. Pectus excavatum (PE) and pectus carinatum (PC) are the two most common chest wall deformities, and many asymptomatic patients visit the clinic. In this study, we presented various strategies for successfully performing breast augmentation in PE and PC patients without long-term complications such as symmastia. METHODS From January of 2019 to December of 2021, a total of 132 patients with tendencies of PE and PC received augmentation mammoplasty in our institute. We retrospectively reviewed data on demographics, surgical procedure, outcomes, and complications. RESULTS Among the 132 cases, 71.21% were done via inframammary approach, and 28.79% via transaxillary approach. The mean implant volume was 337.25 ± 51.46 ml, and the mean follow-up period was 16.48 ± 6.74 months. The Likert scale of outcome satisfaction scored 9.13 ± 0.48. No symmastia occurred. CONCLUSION We presented our basic strategies of breast surgery in patients with various chest wall anomalies. Augmentation mammoplasty can benefit PE and PC patients physically as well as psychologically, to carry out healthy positive lives. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Akhtar M, Razick DI, Saeed A, Baig O, Kamran R, Ansari U, Sajid Z, Rahman JE. Complications and Outcomes of the Nuss Procedure in Adult Patients: A Systematic Review. Cureus 2023; 15:e35204. [PMID: 36960268 PMCID: PMC10031548 DOI: 10.7759/cureus.35204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
Pectus excavatum is a congenital chest wall deformity, commonly identified in early childhood, creating a "sunken chest" appearance. Over time, the deformity can worsen, thus impacting cardiopulmonary function and creating significant body image disturbance in patients. The Nuss procedure is a minimally invasive technique in which a curved steel bar is introduced underneath the sternum through small bilateral thoracic incisions to correct the deformity. Most studies regarding the procedure to date focus on outcomes and complications in pediatric patients, however, few studies discuss these results in adult patients. This systematic review aims to analyze common complications and outcomes in patients over the age of 18 who have not undergone any prior intervention for pectus excavatum. The most common complications experienced in adult patients were displacement of the implanted steel bar, infection of the surgical site, pneumothorax, pleural effusion, and chronic postoperative pain. Reoperation was common in patients with a displacement of the bar, chronic pain, and bleeding. Additionally, adult patients routinely required a higher number of steel bars to be placed to correct the deformity. Despite evidence that the rate of complications increases with age, the majority of adult patients in our included studies were satisfied with the outcome of the procedure with indications of improved self-image and reduced preoperative symptoms such as dyspnea on exertion, palpitations, chest pain, and depression.
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Affiliation(s)
- Muzammil Akhtar
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Daniel I Razick
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Ali Saeed
- Internal Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Osamah Baig
- Ophthalmology, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Rafaay Kamran
- Molecular Biology, University of California Berkeley, Berkeley, USA
| | - Ubaid Ansari
- Internal Medicine, California Northstate University College of Medicine, Elk Grove, USA
| | - Zahra Sajid
- Biology, Cosumnes River College, Elk Grove, USA
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5
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Viggiano D, Bongiolatti S, Borgianni S, Lo Piccolo R, Voltolini L, Gonfiotti A. Nuss Technique for Pectus Excavatum in Adult Patients: Cosmetic Satisfaction and Improvement of Quality of Life in a Single-Center Experience. Front Surg 2022; 9:903791. [PMID: 35722532 PMCID: PMC9198457 DOI: 10.3389/fsurg.2022.903791] [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: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Since its introduction, the Nuss minimally invasive procedure for pectus excavatum (PE) repair (MIRPE) has become the method of choice. The current study describes our experience of PE correction in adults, with particular focus on postoperative outcomes, pain, quality of life, and patients’ satisfaction. Methods We enrolled for this observational study n = 93 adult patients from 2011 to 2018. The Haller index was used to quantify PE severity. Pulmonary function tests and cardiac examinations were performed preoperatively; we developed a standardized surgical technique and postoperative treatment, including follow-up at 3, 12, and 24 months after surgery and 6 months after bar removal. We also evaluated the quality of life and the satisfaction with the cosmetic result after the procedure with standardized questionnaires. Results No operative or perioperative deaths occurred nor life-treating complications. Thirteen complications occurred in 12 patients, with a total complication rate of 14% (n = 13/93). Pain intensity decreased in the follow-up [pain score visual analog scale at 3 months: median 1 (0–8); 12 months: median 1 (0–5); and 24 months: median 1 (0–4)]. Better or much better quality of life after the Nuss procedure was observed: n = 79 (84.1%) at 3 months, n = 80 (86%) at 12 months, and n = 85 (91.4%) at 24 months. After 2 years of observation, more than 90% of patients described improvement in their quality of life and satisfaction with the cosmetic results. Only a very small group of patients suffered from pain in the follow-up. Conclusion Our results demonstrate that the MIRPE procedure is safe and can be performed with excellent results in adults both for improvement of quality of life and for satisfaction with cosmetic results.
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Affiliation(s)
- Domenico Viggiano
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
- Correspondence: Domenico Viggiano
| | | | - Sara Borgianni
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, University of Florence and Children’s University Hospital A. Meyer, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
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Coughlin AC, Ahsanuddin S, Inglesby D, Fox C, Xu H, Margulies I, Sayegh F, Soudant C, Sacks HS, Kaufman A, Taub PJ. "When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis". Pediatr Surg Int 2022; 38:365-375. [PMID: 35006367 DOI: 10.1007/s00383-021-05049-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The optimal age for minimally invasive repair of pectus excavatum (MIRPE) is unclear; this study investigates the differences in complication rates among different age groups undergoing repair. METHODS PubMed and Embase databases were searched from inception to October 2020. To assess age as a risk factor for complications, odds ratios from relevant studies were analyzed using the Mantel-Haenszel method with a random-effects model for younger vs older patients. Specific complication rates were compared between the two cohorts using a chi-squared test. RESULTS Of the 4448 studies retrieved, 25 studies stratified complication data by age groups. From these studies, ten studies compared groups at ages < 18 and ≥ 18 and four studies compared ages < 20 and ≥ 20, and one study compared ages < 19 and ≥ 19. These fifteen studies reported on 5978 patients, with 1188 complications, for a complication rate of 19.87%. Older patients were more likely to have complications in a pooled analysis of studies comparing older vs younger patients (OR = 1.66, 95% CI = 1.28-2.14, heterogeneity I2 = 49%). Specifically, older patients were significantly more likely to experience pneumothorax, pleural effusion, wound infection, bar displacement, and reoperations. CONCLUSION Increased age is a risk factor for complications of MIRPE. This supports repair of pectus excavatum prior to late adolescence.
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Affiliation(s)
- Arielle C Coughlin
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Sofia Ahsanuddin
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Dani Inglesby
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Conner Fox
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Hope Xu
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Ilana Margulies
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Farah Sayegh
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Celine Soudant
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Henry S Sacks
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Kaufman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter J Taub
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA.
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Houle MC, Sjulin TJ, McInnis IC, Walter RJ, Morris MJ. Clinical Evaluation of Exertional Dyspnea in Adult Pectus Excavatum Patients. CURRENT RESPIRATORY MEDICINE REVIEWS 2022. [DOI: 10.2174/1573398x18666220128110107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract:
Evaluation of patients with pectus excavatum has primarily been focused on the pediatric population who undergo surgical correction of sternal defects mainly for cosmetic reasons combined with exercise-limiting symptoms. The extent of cardiopulmonary improvement in this population based on cardiac imaging, pulmonary function testing, and cardiopulmonary exercise testing may be highly variable. There is no current consensus on the limitations of cardiopulmonary impairment or potential improvement from surgical repair in pediatric patients. Limited data has published in the medical literature on the evaluation of adults with pectus excavatum who may also present with a variety of clinical symptoms. Adult patients with exercise limitation and pectus excavatum may present with exertional dyspnea, chest discomfort, palpitations/tachycardia, exercise-induced wheezing, and use of bronchodilators for asthma-like symptoms. While numerous published review articles outline clinical evaluation and surgical treatment for younger patients, comprehensive evaluation for these adult patients has not been fully elucidated. There is no current consensus on the underlying cause of cardiopulmonary impairment in adult patients or their potential improvement from surgical repair. This review focuses on the recommended evaluation of adult patients to discern the potential cardiopulmonary limitations to exercise due to pectus excavatum, especially in physically fit adults such as active duty military personnel. Two illustrative cases are presented to describe the complexity of the evaluation of adult patients and potential need for surgical correction.
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Affiliation(s)
- Mateo C. Houle
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX , USA
| | - Tyson J. Sjulin
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX , USA
| | - Ian C. McInnis
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX , USA
| | - Robert J. Walter
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX , USA
| | - Michael J. Morris
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX , USA
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Norlander L, Sundqvist AS, Anderzén-Carlsson A, Dreifaldt M, Andreasson J, Vidlund M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6526194. [PMID: 35142354 PMCID: PMC9252118 DOI: 10.1093/icvts/ivac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Louise Norlander
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Corresponding author. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Södra Grev Rosengatan, 701 85 Örebro, Sweden. Tel: 0046-196025118; e-mail: (L. Norlander)
| | - Ann-Sofie Sundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Agneta Anderzén-Carlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Dreifaldt
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Jesper Andreasson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mårten Vidlund
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
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Krstevska-Konstantinova M, Kuzevska-Maneva K, Nestorov H, Georgieva D. Association of Poland Syndrome and hypertrichosis in pubertal girl - Case report. Arch Public Health 2021. [DOI: 10.3889/aph.2021.6003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Poland syndrome (PS) is a rare congenital malformation, most commonly characterized by absence of chest wall muscles on one side of the body. It may be accompanied with other deformities of the extremities. We present the case of a 10-year-old girl with Poland syndrome and hypertrichosis of the back of the trunk and extremities. The clinical examination did not reveal the etiology of the syndrome, such as familial predisposition or some event that led to interrupted blood flow during the early embionic growth. The pregnancy was concieved with in vitro fertilization (IVF); triplets were born and our patient is one of these three girls. The hypertrychosis appeared at 8 years of life, without evidence of previous familial occurance, medications or hormonal disbalance. Other malformations that were found were: a mild form of kyphoscoliosis and mitral valve prolapse. The child was evaluated using a multidisciplinary approach, with further follow-up planned with surgical correction of the chest wall and breast augmentation.
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Comparison of physical functions and psychosocial conditions between adolescents with pectus excavatum, pectus carinatum and healthy controls. Pediatr Surg Int 2021; 37:765-775. [PMID: 33454849 DOI: 10.1007/s00383-021-04857-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aimed to compare the physical and psychosocial conditions of adolescents with pectus excavatum (PE) and pectus carinatum (PC), who had mild-severe deformities, with those of healthy controls (HC). METHODS This study included 180 adolescents (aged 10-18 years) with pectus deformity [PE (n = 90) and PC (n = 90)] and 90 age-matched HC. The following parameters were evaluated for each participant: clinical parameters, perceived appearance of the chest area (PAC), physical functions (grip strength, flexibility, muscle strength, endurance, physical activity), posture, psychosocial conditions, and quality of life (QOL). RESULTS Patients with PE and PC had a lower body weight, a worse, a poorer posture, lower scores for physical functions compared to the HC group (p < 0.001, all). The PE group had lower scores (p < 0.05) for some psychosocial conditions and quality of life subscales compared to the HC and PC (except for the QOL) group (p < 0.05). The PC group had a poorer posture compared to the PE group (p < 0.05). PAC was associated with physical functions and psychosocial status (r = 0.19-0.40, p < 0.05) but pectus severity was not associated with these parameters (r = 0.02-0.12, p > 0.05). CONCLUSION Our results indicate that all adolescents with mild, moderate, or severe pectus deformity should undergo a biopsychosocial evaluation, receive psychosocial support, and be referred for physiotherapy.
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Okuyama H, Tsukada R, Tazuke Y, Ueno T, Watanabe M, Nomura M, Masahata K, Saka R, Deguchi K. Thoracoscopic Costal Cartilage Excision Combined with the Nuss Procedure for Patients with Asymmetrical Pectus Excavatum. J Laparoendosc Adv Surg Tech A 2020; 31:95-99. [PMID: 33227219 DOI: 10.1089/lap.2020.0312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Aims: We performed thoracoscopic costal cartilage excision (TCCE) combined with the Nuss procedure to correct asymmetrical pectus excavatum (PE). We reviewed the efficacy of combined TCCE and Nuss procedure for asymmetric PE. Patients and Methods: Overall, 8 patients with asymmetrical PE underwent TCCE with the Nuss procedure. The Haller index, asymmetry index, and angle of sternal rotation were calculated using preoperative computed tomography. The procedure was performed using bilateral 2.5-cm incisions at the same level of the deepest chest wall depression. The most depressed three to four costal cartilages were partially resected through a right mini-thoracotomy. Subsequently, one or two titanium bars were implanted and secured with stabilizers. The cosmetic outcome was evaluated on the following four ratings: excellent, good, fair, and failure ( = recurrence). Results: The median age at surgery was 14.5 years (8-20 years). The number of bars was one in 3 cases and two in 5 cases. The preoperative Haller index, asymmetry index, and angle of sternal rotation were 4.3 (3.5-5.9), 1.15 (1.04-1.26), and 21.5° (15°-31°), respectively; 2 patients had scoliosis before the Nuss procedure. Complications included surgical site infection and hemothorax. Median follow-up time was 25.5 months (3-63). Bars were removed in 3 patients, 3 years postoperatively. Cosmetic results were excellent, 4; good, 2; fair, 1; failure, 1. Both patients with scoliosis had poor outcomes (fair, 1; failure, 1). Conclusions: Combined TCCE with Nuss procedure is considered safe and effective for patients with asymmetrical PE. Careful long-term follow-up is required, especially in cases with scoliosis.
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Affiliation(s)
- Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryo Tsukada
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryuta Saka
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Deguchi
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Beltsios ET, Mitsos SL, Panagiotopoulos NT. Pectus excavatum and scoliosis: a review about the patient's surgical management. Gen Thorac Cardiovasc Surg 2020; 68:1225-1233. [PMID: 32990868 DOI: 10.1007/s11748-020-01496-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Although Nuss procedure is performed with satisfactory results, there has been a controversy in the literature regarding the effect of a Nuss procedure on the spine. This review article aims to perform an updated overview of the literature about the effect of pectus excavatum correction at the spine and the management of patients with both pectus excavatum and scoliosis. Although acquired scoliosis has been rarely reported after a Nuss procedure, studies show that the Nuss procedure can have a beneficial effect in mild coexisting scoliosis especially when it is performed during the adolescence. The management of cases presented with both pectus excavatum and scoliosis depends on the severity of pre-operative scoliosis and demands detailed evaluation of the spine pre and postoperatively. In the rare condition of post-operative scoliosis following a Nuss procedure, the removal of the metallic bar and conservative measures may have satisfactory results on the spine.
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Affiliation(s)
- Eleftherios T Beltsios
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK. .,Department of Medicine, Faculty of Health Sciences, University of Thessaly, Biopolis, 41500, Larissa, Greece.
| | - Sofoklis L Mitsos
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
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Analyzing Outcomes of Nuss and Ravitch Repair for Primary and Recurrent Pectus Excavatum in Adults. Ann Thorac Surg 2020; 110:272-275. [DOI: 10.1016/j.athoracsur.2019.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/21/2019] [Accepted: 12/04/2019] [Indexed: 11/21/2022]
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Pérez D, Martel O, Yánez A, Cano JR, Cuadrado A, Torrent G, López L. Does the modelling of the pectus bar affect its stability? Rationale for using a short flat bar. Interact Cardiovasc Thorac Surg 2019; 30:11-17. [DOI: 10.1093/icvts/ivz217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Although the Nuss procedure for pectus excavatum is still associated with a non-negligible risk of postoperative bar displacement, the potential effects of the length and shape of the bar on its corrective ability and stability have not been sufficiently studied. The aim of this study was to determine how the modelling of the pectus bar affects its stability and whether an alternative configuration of the implant can improve clinical success.
METHODS
Simulated implantation of bars with different shapes and sizes in a computational model was carried out. A 250 N sternal force was applied to the bars, and the resulting forces and moments on the fixation points were identified. Afterwards, a clinical trial was carried out in a group of patients with pectus excavatum, some of whom received long inverted U-shaped bars and some of whom received implants designed from the computational results.
RESULTS
When U-shaped bars were tested, the sternal force generated unbalanced horizontal reaction forces (16 vs 61 N) and large reaction moments at the ends of the bar, conferring the tendency to slide and to rotate, respectively. No lateral or rotational destabilizing forces occurred in the case of a flat bar. Cosmetic outcomes, postoperative times and hospital stays were similar in both clinical groups. However, 2 cases (2/15) of bar flipping occurred in patients who received the conventional bar.
CONCLUSIONS
The shape of the bar is a determinant of its stability. A flat, shorter pectus bar provides adequate correction of the deformity with less tendency for bar displacement in the repair of pectus excavatum.
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Affiliation(s)
- David Pérez
- Thoracic Surgery Section, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Oscar Martel
- Department of Mechanical Engineering, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Alejandro Yánez
- Department of Mechanical Engineering, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - José R Cano
- Thoracic Surgery Section, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Alberto Cuadrado
- Department of Mechanical Engineering, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Gara Torrent
- Thoracic Surgery Section, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Luis López
- Thoracic Surgery Section, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
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Kauffman JD, Benzie AL, Snyder CW, Danielson PD, Chandler NM. Short-term Outcomes After Pectus Excavatum Repair in Adults and Children. J Surg Res 2019; 244:231-240. [PMID: 31301479 DOI: 10.1016/j.jss.2019.06.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/30/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pectus excavatum is a common congenital chest wall deformity often repaired during adolescence, although a subset of patients undergo repair as adults. The goal of our study was to determine the effects of age at repair and repair technique on short-term surgical outcomes. MATERIALS AND METHODS We performed a cohort study of patients in the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Project pediatric (age<18 y) and adult databases who underwent pectus excavatum repair. The primary outcome was the incidence of 30-d complications. Secondary outcomes included length of stay, reoperation, and readmission. Multivariable logistic regression was used to estimate the independent effects of patient age and type of repair on postoperative outcomes. RESULTS Of the 2268 subjects included, 2089 (92.1%) were younger than 18 y. Overall, 3.4% of patients suffered a 30-d complication, and the risk was similar between age groups (risk ratio [RR], 0.69; 95% confidence interval [CI], 0.08-5.03; P = 0.731). Steroid therapy was an independent risk factor for complications (RR, 8.0; 95% CI, 1.9-19.7; P = 0.006). Median length of stay was 4 d (interquartile range, 3-5) and was similar between age groups. Risk for readmission and reoperation were 2.8% and 1.5%, respectively, and were similar for pediatric and adult patients. When comparing minimally invasive repair with and without thoracoscopy, risk for 30-d complications was lower among patients repaired with thoracoscopy (RR, 0.56; CI, 0.32-0.96; P = 0.034). CONCLUSIONS Pediatric and adult patients experience comparable rates of postoperative complications, readmission, and reoperation after pectus excavatum repair. Use of thoracoscopy during minimally invasive repair is associated with lower risk of complications. These findings suggest that thoracoscopy should be used routinely for minimally invasive repair of pectus excavatum.
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Affiliation(s)
- Jeremy D Kauffman
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Annie Laurie Benzie
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
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17
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Liu KS, Chen WH, Lee CH, Su YF, Liu SJ. Extended pain relief achieved by analgesic-eluting biodegradable nanofibers in the Nuss procedure: in vitro and in vivo studies. Int J Nanomedicine 2018; 13:8355-8364. [PMID: 30573957 PMCID: PMC6290868 DOI: 10.2147/ijn.s189505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The most common complaint after the Nuss procedure is severe postoperative chest pain. The aim of this study was to evaluate the effectiveness of analgesic-eluting biodegradable nanofibers in pain relief after the Nuss procedure. Materials and methods Poly(d,l)-lactide-co-glycolide, lidocaine, and ketorolac were dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. This solution was electrospun into a nanofibrous membrane. The elution method and high-performance chromatography were used to characterize the in vitro drug release. Stainless steel bars with and without coating of the analgesic-eluting nanofibrous membrane were implanted underneath the sternums of New Zealand white rabbits. The in vivo characteristics were further investigated. Results The in vitro study showed that the biodegradable nanofibers released high doses of lidocaine and ketorolac within 10 days. The in vivo study demonstrated high local and systemic concentrations of lidocaine and ketorolac. The serum creatinine level was unaffected. Animals that received implants of the analgesic-eluting nanofiber-coated stainless steel bar exhibited significantly greater food and water ingestion and physical activity than the control group did, indicating effective pain relief. Conclusion The proposed analgesic-eluting biodegradable nanofibers contribute to the achievement of extended pain relief after the Nuss procedure, without obvious adverse effects, in an animal model.
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Affiliation(s)
- Kuo-Sheng Liu
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Wei-Hsun Chen
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Yong-Fong Su
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan, Republic of China,
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan, Republic of China, .,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China,
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Abstract
The adverse physiologic effects of pectus excavatum and subsequent resolution following correction have been a subject of controversy. There are numerous accounts of patients reporting subjective improvement in exercise tolerance after surgery, but studies showing clear and consistent objective data to corroborate this phenomenon physiologically have been elusive. This is partially due to a lack of consistent study methodologies but even more so due to a mere paucity of data. As experts in the repair of pectus excavatum, it is not uncommon for pediatric surgeons to operate on adult patients. For this reason, this review evaluates the contemporary literature to provide an understanding of the physiologic impact of repairing pectus excavatum on pediatric and adult patients separately.
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Affiliation(s)
- Robert J Obermeyer
- Children's Hospital of The King's Daughters, Norfolk, VA, USA ; Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Nina S Cohen
- Eastern Virginia Medical School, Norfolk, VA, USA
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Velazco CS, Arsanjani R, Jaroszewski DE. Nuss procedure in the adult population for correction of pectus excavatum. Semin Pediatr Surg 2018; 27:161-169. [PMID: 30078487 DOI: 10.1053/j.sempedsurg.2018.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Minimally invasive repair of pectus excavatum has been successfully modified for use in adult patients. Many patients present in adulthood with progression of symptoms as the chest wall becomes less compliant with age. A thorough workup is completed including echocardiogram and chest CT to evaluate for anatomic abnormalities. Cardiopulmonary exercise testing is done to quantify the physiologic impact. Modifications of the original Nuss procedure required to allow for successful adult repair include the use of forced sternal elevation, the use of multiple bars, medial bar fixation, and interspace support to prevent bar rotation and migration. Occasionally, fractures may occur that require an open procedure and osteotomy or cartilage resection and hybrid approach incorporating the principals of intrathoracic support and osteotomy with bar stabilization.
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Affiliation(s)
- Cristine S Velazco
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Dawn E Jaroszewski
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States.
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Gui L, Shen S, Mei W. Anaesthesia for chest wall reconstruction in a patient with Poland syndrome: CARE-compliant case report and literature review. BMC Anesthesiol 2018; 18:57. [PMID: 29793431 PMCID: PMC5968485 DOI: 10.1186/s12871-018-0518-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poland syndrome is a rare congenital disease, characterized by agenesis/hypoplasia of the pectoralis major muscle, usually associated with variable thoracic anomalies that needed chest wall reconstruction under general anesthesia. Anaesthetic management in Poland syndrome has scarcely been described. CASE PRESENTATION Here, we present our anaesthetic management of Nuss procedure for chest wall correction in a 5 years old patient with Poland syndrome. We also reviewed the reports of anaesthetic management of Poland syndrome by searching Pubmed, and summarize the perioperative procedures that may warrant a safe surgery. CONCLUSIONS Examinations before surgery, intraoperative monitoring, choice of general anesthetics and pain management after surgery should all be contemplated.
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Affiliation(s)
- Lingli Gui
- Department of Anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China
| | - Shiqian Shen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachsetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02129, USA
| | - Wei Mei
- Department of Anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China.
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Ashfaq A, Beamer S, Ewais MM, Lackey J, Jaroszewski D. Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum. Ann Thorac Surg 2018; 105:371-378. [DOI: 10.1016/j.athoracsur.2017.08.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/28/2017] [Accepted: 08/25/2017] [Indexed: 11/26/2022]
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Ewais MM, Chaparala S, Uhl R, Jaroszewski DE. Outcomes in adult pectus excavatum patients undergoing Nuss repair. PATIENT-RELATED OUTCOME MEASURES 2018; 9:65-90. [PMID: 29430201 PMCID: PMC5796466 DOI: 10.2147/prom.s117771] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pectus excavatum (PEx) is one of the most common congenital chest wall deformities. Depending on the severity, presentation of PEx may range from minor cosmetic issues to disabling cardiopulmonary symptoms. The effect of PEx on adult patients has not been extensively studied. Symptoms may not occur until the patient ages, and they may worsen over the years. More recent publications have implied that PEx may have significant cardiopulmonary implications and repair is of medical benefit. Adults presenting for PEx repair can undergo a successful repair with a minimally invasive "Nuss" approach. Resolution of symptoms, improved quality of life, and satisfying results are reported.
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Affiliation(s)
- MennatAllah M Ewais
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Shivani Chaparala
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Rebecca Uhl
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Dawn E Jaroszewski
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
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24
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Complex corrective procedure in surgical treatment of asymmetrical pectus excavatum. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:110-114. [PMID: 28747942 PMCID: PMC5519836 DOI: 10.5114/kitp.2017.68741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/11/2017] [Indexed: 11/21/2022]
Abstract
Aim In this study we analysed the early and late results of surgical treatment of asymmetrical pectus excavatum using complex surgery combining the Ravitch procedure and the Nuss procedure in the same general anaesthesia. Material and methods Eighty out of 938 patients with pectus excavatum operated on between 2002 and 2013, 67 males and 13 females aged 11 to 49 years (mean: 19.2), underwent a complex surgical procedure. During surgery the Nuss procedure was usually performed first (one corrective bar was implanted in 35 patients and two bars were inserted in 45 patients). Because of the unsatisfactory cosmetic effect, additionally the Ravitch procedure was started. The bars were electively removed 3 years after the primary operation. Results No mortality was observed in the early postoperative period. Non-life-threatening and transient postoperative complications occurred in 44 (55%) patients. The most common was pleural effusion (21%), which in 50% of patients required pleural drainage. A satisfactory and stable correction effect was achieved in 88% of cases. Six of those patients required repeat surgery due to recurrence of deformity. Conclusions A complex corrective procedure is a successful method of surgical treatment in patients with asymmetrical pectus excavatum and is characterized by satisfactory postoperative results. The use of corrective bars enhances the cosmetic effect. The frequency of early, mostly non-life-threatening postoperative complications after a complex procedure is insignificantly higher than that after the Nuss procedure.
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25
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Complications after pectus excavatum repair using pectus bars in adolescents and adults: risk comparisons between age and technique groups†. Interact Cardiovasc Thorac Surg 2017; 25:606-612. [DOI: 10.1093/icvts/ivx162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 11/14/2022] Open
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Li S, Yang D, Ma Y, Tang ST, Yang L, Li S, Cao G, Li K, Zhang X, Hu X. Hybrid Nuss Procedure for Pectus Excavatum With Severe Retrosternal Adhesions After Sternotomy. Ann Thorac Surg 2017; 103:1573-1577. [DOI: 10.1016/j.athoracsur.2016.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/28/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Successful Treatment of Persistent Pain After Pectus Excavatum Repair Using Paravertebral Nerve Radiofrequency Thermoablation. ACTA ACUST UNITED AC 2017; 8:18-20. [PMID: 27811494 DOI: 10.1213/xaa.0000000000000411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a case of a 25-year-old male patient suffering from severe prolonged pain after uneventful pectus excavatum repair that could be treated successfully by paravertebral nerve radiofrequency thermoablation. The patient was scheduled for a minimally invasive Nuss pectus excavatum repair. Surgical correction was performed under general anesthesia in combination with a thoracic peridural catheter. The immediate postoperative course was uneventful; however, the patient developed severe prolonged bilateral chest wall pain across segments T8 and T9. After failure of conservative treatment options, a specialized interventional anesthesiologist performed paravertebral nerve radiofrequency thermoablation of segment T9 bilaterally, after which the patient was pain free until scheduled removal of the pectus bar 3 years after placement.
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28
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Pechetov AA, Esakov YS, Gubaydullina GF, Makov MA, Khlan TN. [Differential approach for chest wall reconstruction for pectus excavatum in adults]. Khirurgiia (Mosk) 2017:24-29. [PMID: 28745702 DOI: 10.17116/hirurgia2017724-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To perform the prospective non-randomized single-center trial of pectus excavatum correction in adults. MATERIAL AND METHODS For the period March 2012 - March 2016 64 patients aged 18-44 years were treated. Median age was 23 years. Male/female ratio was 41/23. All patients were included into standard survey protocol: chest MDCT, MRI of thoracic spine, pulmonary function test, echocardiography. Quality of life and complications rate after the Nuss procedure (n=50, 78.1%, group 1) and radical thoracoplasty using nikelid-titanium bar (n=14, group 2) were evaluated. RESULTS There was earlier recovery in the 1st group: 3 (2; 4) and 6 (5; 7) days after minimally invasive and radical thoracoplasty, respectively. Postoperative Dindo-Clavien I-IIIa complications developed in 46 (71.8%) patients. Most of them did not require additional procedures. CONCLUSION Nuss procedure is safe method and can be performed with good results in adults.
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Affiliation(s)
- A A Pechetov
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu S Esakov
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - G F Gubaydullina
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - M A Makov
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - T N Khlan
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
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Jaroszewski DE, Temkit M, Ewais MM, Luckritz TC, Stearns JD, Craner RC, Gaitan BD, Ramakrishna H, Thunberg CA, Weis RA, Myers KM, Merritt MV, Rosenfeld DM. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults. J Thorac Dis 2016; 8:2102-10. [PMID: 27621865 DOI: 10.21037/jtd.2016.06.62] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). METHODS Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. RESULTS Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0-58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system. CONCLUSIONS Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management.
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Affiliation(s)
- Dawn E Jaroszewski
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - M'hamed Temkit
- Department of Biostatistics, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - MennatAllah M Ewais
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Todd C Luckritz
- Department of Pharmacy, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Joshua D Stearns
- Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Ryan C Craner
- Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Brantley D Gaitan
- Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Harish Ramakrishna
- Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | | | - Ricardo A Weis
- Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Kelly M Myers
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Marianne V Merritt
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - David M Rosenfeld
- Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Kanagaratnam A, Phan S, Tchantchaleishvili V, Phan K. Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis. Ann Cardiothorac Surg 2016; 5:409-421. [PMID: 27747174 DOI: 10.21037/acs.2016.08.06] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pectus excavatum is the most common congenital chest wall deformity. The two most common surgical techniques for its correction are the modified Ravitch technique and the minimally invasive Nuss technique. Despite both procedures being used widely, data comparing them are scarce. METHODS We conducted a systematic review and meta-analysis of comparative studies to evaluate these procedures. A systematic search of the literature was performed from six electronic databases. Pooled meta-analysis was conducted using odds ratio (OR) and weighted mean difference (WMD). RESULTS A total of 13 studies comprising 1,432 pediatric (79.3%) and adult (20.7%) patients were identified, including 912 patients undergoing the Nuss procedure compared to 520 patients undergoing the Ravitch procedure. There was no significant difference found between the Nuss group versus Ravitch group in pediatric patients with regard to overall complications (OR =1.16; 95% CI: 0.61-2.19; I2=56%; P=0.65), reoperations (6.1% vs. 6.4%; OR =1.00; 95% CI: 0.40-2.50; I2=0%; P=1.00), wound infections (OR =0.58; 95% CI: 0.23-1.46; I2=0%; P=0.25), hemothorax (1.6% vs. 1.3%; OR =0.74; 95% CI: 0.21-2.65; I2=12%; P=0.64), pneumothorax (3.4% vs. 1.5%; OR =1.11; 95% CI: 0.42-2.93; I2=0%; P=0.83) or pneumonia (OR =0.15; 95% CI: 0.02-1.48; I2=0%; P=0.10). Adult patients undergoing the Nuss procedure had a higher incidence of overall complications (OR =3.26; 95% CI: 1.01-10.46; I2=0%; P=0.05), though there were far fewer studies that reported data. CONCLUSIONS These results suggest no difference between the Nuss and Ravitch procedures for pediatric patients, while in adults the Ravitch procedure resulted in fewer complications.
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Affiliation(s)
- Aran Kanagaratnam
- Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Steven Phan
- Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | | | - Kevin Phan
- Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Jaroszewski DE, Ewais MM, Chao CJ, Gotway MB, Lackey JJ, Myers KM, Merritt MV, Sims SM, McMahon LE, Notrica DM. Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years). Ann Thorac Surg 2016; 102:993-1003. [DOI: 10.1016/j.athoracsur.2016.03.105] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 02/17/2016] [Accepted: 03/31/2016] [Indexed: 11/28/2022]
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32
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Early and Late Results of the Nuss Procedure in Surgical Treatment of Pectus Excavatum in Different Age Groups. Ann Thorac Surg 2016; 102:1711-1716. [PMID: 27373189 DOI: 10.1016/j.athoracsur.2016.04.098] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was a comparison of early and late results in surgical treatment of funnel chest using the Nuss method in patients in various age groups to find the optimal age to perform the corrective procedure. METHODS Six hundred eighty patients operated on from June 2002 to October 2012 were included in the retrospective analysis. Patients were divided into 3 different age groups: group A = 156 patients from 7 to 14 years, group B = 328 patients aged 15 to 20 years, and group C = 196 patients older than 20 years of age. The mean follow-up was 33 months. RESULTS Early non-life-threatening complications developed in 238 (35.0%) patients and frequency increased with age (group A, 24.3%; group B, 37.8%; group C, 38.8%; p = 0.0063). Good and very good corrective effects were achieved in 97.7 % of the entire patient population. Recurrence of the deformity was observed more often in younger patients (group A, 3.2 %) than in the other patients (group B, 1.2%; group C, 1.5%), although the difference between the studied groups was not significant (p = 0.3251). CONCLUSIONS Good cosmetic results obtained with the use of the Nuss operation were not related to the age of the patients. The high incidence of minor complications in older patients seems to be an acceptable cost of a good cosmetic outcome and stable correction. Surgical morbidity is lowest in younger patients; however, the frequency of the recurrence of deformation is higher than in other groups.
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Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice? Wideochir Inne Tech Maloinwazyjne 2016; 11:98-104. [PMID: 27458490 PMCID: PMC4945611 DOI: 10.5114/wiitm.2016.60456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Nuss procedure is suitable for prepubertal and early pubertal patients but can also be used in adult patients. AIM To determine whether the minimally invasive technique (MIRPE) can also be performed successfully in adults. MATERIAL AND METHODS Between July 2006 and January 2016, 836 patients (744 male, 92 female) underwent correction of pectus excavatum with the MIRPE technique at our institution. The mean age was 16.8 years (2-45 years). There were 236 adult patients (28.2%) (> 18 years) - 20 female, 216 male. The mean age among the adult patients was 23.2 years (18-45 years). The recorded data included length of hospital stay, postoperative complications, number of bars used, duration of the surgical procedure and signs of pneumothorax on the postoperative chest X-ray. RESULTS The MIRPE was performed in 236 adult patients. The average operative time was 44.4 min (25-90 min). The median postoperative stay was 4.92 ±2.81 days (3-21 days) in adults and 4.64 ±1.58 (2-13) in younger patients. The difference was not statistically significant (p = 0.637). Two or more bars were used in 36 (15.8%) adult patients and in 44 (7.5%) younger patients. The difference was not statistically significant either (p = 0.068). Regarding the overall complications, complication rates among the adult patients and younger patients were 26.2% and 11.8% respectively. The difference was statistically significant (p = 0.007). CONCLUSIONS MIRPE is a feasible procedure that produces good long-term results in the treatment of pectus excavatum in adults.
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Hoksch B, Kocher G, Vollmar P, Praz F, Schmid RA. Nuss procedure for pectus excavatum in adults: long-term results in a prospective observational study. Eur J Cardiothorac Surg 2016; 50:934-939. [DOI: 10.1093/ejcts/ezw130] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/18/2016] [Indexed: 11/13/2022] Open
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Sacco Casamassima MG, Gause C, Goldstein SD, Karim O, Swarup A, McIltrot K, Yang J, Abdullah F, Colombani PM. Patient Satisfaction After Minimally Invasive Repair of Pectus Excavatum in Adults: Long-Term Results of Nuss Procedure in Adults. Ann Thorac Surg 2016; 101:1338-45. [DOI: 10.1016/j.athoracsur.2015.09.102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/18/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022]
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Fibla JJ, Molins L, Moradiellos J, Rodríguez P, Heras F, Canalis E, Bolufer S, Martínez P, Aragón J, Arroyo A, Pérez J, León P, Canela M. Experience with the Nuss technique for the treatment of Pectus Excavatum in Spanish Thoracic Surgery Departments. Cir Esp 2015; 94:38-43. [PMID: 26546550 DOI: 10.1016/j.ciresp.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/18/2015] [Accepted: 08/07/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although the Nuss technique revolutionized the surgical treatment of pectus excavatum, its use has not become widespread in our country. The aim of this study was to analyze the current use of this technique in a sample of Thoracic Surgery Departments in Spain. METHODS Observational rectrospective multicentric study analyzing the main epidemiological aspects and clinical results of ten years experience using the Nuss technique. RESULTS Between 2001 and 2010 a total of 149 patients were operated on (mean age 21.2 years), 74% male. Initial aesthetic results were excellent or good in 93.2%, mild in 4.1% and bad in 2.7%. After initial surgery there were complications in 45 patients (30.6%). The most frequent were wound seroma, bar displacement, stabilizer break, pneumothorax, haemothorax, wound infection, pneumonia, pericarditis and cardiac tamponade that required urgent bar removal. Postoperative pain appeared in all patients. In 3 cases (2%) it was so intense that it required bar removal. After a mean follow-up of 39.2 months, bar removal had been performed in 72 patients (49%), being difficult in 5 cases (7%). After a 1.6 year follow-up period good results persisted in 145 patients (98.7%). CONCLUSION Nuss technique in adults has had good results in Spanish Thoracic Surgery Departments, however its use has not been generalized. The risk of complications must be taken into account and its indication must be properly evaluated. The possibility of previous conservative treatment is being analyzed in several departments at present.
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Affiliation(s)
- Juan J Fibla
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España.
| | - Laureano Molins
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España; Cirugía Torácica, Hospital Clinic, Barcelona, España
| | - Javier Moradiellos
- Cirugía Torácica, Hospital Puerta de Hierro, Majadahonda (Madrid), España
| | - Pedro Rodríguez
- Cirugía Torácica, Hospital Insular de Las Palmas de Gran Canaria, Las Palmas, España
| | - Félix Heras
- Cirugía Torácica, Hospital Clínico Universitario, Valladolid, España
| | - Emili Canalis
- Cirugía Torácica, Hospital Universitari Joan XXIII, Tarragona, España
| | - Sergio Bolufer
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - Pablo Martínez
- Cirugía Torácica, Hospital Miguel Servet, Zaragoza, España
| | - Javier Aragón
- Cirugía Torácica, Hospital Universitario Central de Asturias, Oviedo, España
| | - Andrés Arroyo
- Cirugía Torácica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Javier Pérez
- Cirugía Torácica, Hospital Germans Trias i Pujol, Badalona, España
| | - Pablo León
- Cirugía Torácica, Complejo Hospitalario Universitario, Albacete, España
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Zhang DK, Tang JM, Ben XS, Xie L, Zhou HY, Ye X, Zhou ZH, Shi RQ, Xiao P, Chen G. Surgical correction of 639 pectus excavatum cases via the Nuss procedure. J Thorac Dis 2015; 7:1595-605. [PMID: 26543607 DOI: 10.3978/j.issn.2072-1439.2015.09.30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To review the clinical experience and short- to middle-term effects of the Nuss procedure for correction of pectus excavatum (PE). METHODS From September 2006 to August 2014, 639 patients with PE were treated using the Nuss procedure. Of these, 546 were male and 93 were female. The mean age was 15.3±5.8 years (2.5-49 years). Preoperative chest CT scans Haller index (HI) was 4.3±1.7 (2.9-17.4), with 75 cases of mild PE (HI <3.2), 114 cases of moderate PE (HI 3.2-3.5), 393 cases of severe PE (HI 3.6-6.0), and 57 cases of extremely severe PE (HI >6.0). RESULTS A total of 638 patients successfully completed the surgery, an 11-year-old male patient who died after the surgery had undergone ventricular septal defect closure surgery through a sternal incision 7 years ago. The mean operative time was 64.3±41.7 min (40-310 min). Excluding the patient who died, the average blood loss was 24.5±17.8 mL (10-160 mL). The average length of postoperative hospital stay was 5.2±2.9 days (4-36 days). A total of 484 cases (75.7%) required 1 steel bar insertion, 153 cases (24.0%) required 2 steel bars, and 2 cases (0.3%) required 3 bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 504 cases, good in 105, fair in 28 and poor in 2, good quality rate was 95.3%. CONCLUSIONS Correction of PE via the Nuss procedure is minimally invasive and simple to perform with good short and mid-term effects, while long-term efficacy remains to be determined.
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Affiliation(s)
- Dong-Kun Zhang
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ji-Ming Tang
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiao-Song Ben
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Liang Xie
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hai-Yu Zhou
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiong Ye
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zi-Hao Zhou
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Rui-Qing Shi
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Pu Xiao
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Gang Chen
- 1 Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China ; 2 Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Comments on the article "Clinical application of Nuss procedure for chest wall deformity in Poland syndrome". POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 11:424. [PMID: 26336461 PMCID: PMC4349046 DOI: 10.5114/kitp.2014.47344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Soccorso G, Parikh DH, Worrollo S. Customized silicone implant for the correction of acquired and congenital chest wall deformities: A valuable option with pectus excavatum. J Pediatr Surg 2015; 50:1232-5. [PMID: 25957023 DOI: 10.1016/j.jpedsurg.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/12/2015] [Accepted: 04/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical remodeling and correction of congenital and acquired chest wall deformities (CWD) is undertaken many times for cosmesis. Although reportedly minimally invasive, commonly used Nuss procedure for correction of pectus excavatum (PE) is not without complications. Nuss procedure is also not suitable for complex deformities and Poland syndrome cases. Insertion of custom-made silicone implants for the reconstruction of defects has been adopted from adult plastic reconstructive surgery as primary repair of CWD or rescue procedure for recurrence of PE after recurrence or residual deformity. METHODS We present our experience with CWD reconstruction in children with customized silicone prosthesis made from a surgically implantable liquid silicone rubber (NuSil MED-4805, Ca). RESULTS Since 2006 we treated 26 patients with CWD: six were children (age <17years, median 14.6) with PE. Implants were custom made for each patient's chest. The implants were inserted under general anesthesia. Postoperatively all patients were fully satisfied with the cosmetic result and subjective patient satisfaction remained excellent at follow-up in all the children. Only one child developed postoperative complications (seroma). CONCLUSIONS Customized silicone implant for PE in the pediatric age is an alternative therapeutic method, as primary or rescue treatment, with equally good cosmetic outcome, fewer significant complications, less postoperative pain and a faster recovery.
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Affiliation(s)
- Giampiero Soccorso
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom.
| | - Dakshesh H Parikh
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Steve Worrollo
- Maxillofacial Prosthetics Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Oblique lateral incision and subpectoral dissection in modified Nuss procedure minimize future breast deformity. J Plast Reconstr Aesthet Surg 2015; 68:692-7. [DOI: 10.1016/j.bjps.2014.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 11/18/2014] [Accepted: 12/13/2014] [Indexed: 11/23/2022]
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Bahadir AT, Kuru P, Afacan C, Ermerak NO, Bostanci K, Yuksel M. Validity and reliability of the Turkish version of the nuss questionnaire modified for adults. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:112-9. [PMID: 25883894 PMCID: PMC4398161 DOI: 10.5090/kjtcs.2015.48.2.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pectus excavatum (PE) is the most common chest wall deformity. The Nuss Questionnaire modified for Adults (NQmA) is a disease-specific health-related quality of life assessment tool for patients with pectus deformities. The aim of this study is to adapt the NQmA into Turkish. METHODS Two hundred and sixty-five patients with PE were participated, with an age range of 14 to 29 years. All patients underwent a physical examination and had not undergone corrective surgery. The Turkish version of the NQmA was completed by patients and their parents. RESULTS The content validity index based on expert opinions was 91% for the patient questionnaire and 96% for the parent questionnaire. The Cronbach's alpha value for the NQmA was found to be 0.805 for the patient questionnaire and 0.800 for the parent questionnaire. Exploratory factor analysis was used to assess construct validity. Two factors explained 51.1% of the total variance in the patient questionnaire (psychosocial: 31.145%, Cronbach's alpha=0.818; physical: 19.955%, Cronbach's alpha=0.862). In the parent questionnaire, two factors explained 51.422% of the total variance (psychosocial: 26.097%, Cronbach's alpha=0.743; physical: 25.325%, Cronbach's alpha=0.827). Construct validity was confirmed by confirmatory factor analysis. CONCLUSION The Turkish version of the NQmA was found to be valid and reliable for the assessment of quality of life in patients with PE.
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Affiliation(s)
- A Tugba Bahadir
- Department of Child & Adolescent Psychiatry, Northwestern University Feinberg School of Medicine
| | - Pinar Kuru
- Department of Neurology, Northwestern University Feinberg School of Medicine
| | - Ceyda Afacan
- Statistical Expert, Marmara University School of Medicine
| | | | - Korkut Bostanci
- Department of Thoracic Surgery, Marmara University School of Medicine
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Marmara University School of Medicine
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Kanani M, Elliott MJ, Withey S, Pearl R. Chest wall reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rodrigues PL, Rodrigues NF, Pinho ACM, Fonseca JC, Correia-Pinto J, Vilaça JL. Automatic modeling of pectus excavatum corrective prosthesis using artificial neural networks. Med Eng Phys 2014; 36:1338-45. [DOI: 10.1016/j.medengphy.2014.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 06/20/2014] [Accepted: 06/28/2014] [Indexed: 11/26/2022]
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Johnson WR, Fedor D, Singhal S. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. J Cardiothorac Surg 2014; 9:25. [PMID: 24506826 PMCID: PMC3922335 DOI: 10.1186/1749-8090-9-25] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 02/04/2014] [Indexed: 11/16/2022] Open
Abstract
This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric=0-21; adult 17-99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation.
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Affiliation(s)
- William Rainey Johnson
- Department of Surgery, Thoracic Surgery Research Laboratory, Perelman School of Medicine, Philadelphia, PA, USA
| | - David Fedor
- Department of Surgery, Thoracic Surgery Research Laboratory, Perelman School of Medicine, Philadelphia, PA, USA
| | - Sunil Singhal
- Department of Surgery, Thoracic Surgery Research Laboratory, Perelman School of Medicine, Philadelphia, PA, USA
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Hamaji M, Hiraoka K, Jaroszewski DE, Deschamps C. Modified Robicsek procedure for pectus excavatum in adult patients. Interact Cardiovasc Thorac Surg 2014; 18:611-4. [PMID: 24457817 DOI: 10.1093/icvts/ivt555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to clarify the short-term and mid-term outcomes of the modified Robicsek procedure using polypropylene mesh for adult pectus excavatum patients. METHODS Retrospective chart review was performed. Between 2001 and 2012, 46 consecutive adult patients underwent modified Ravitch repair using polypropylene mesh for pectus excavatum at our institution. There were 30 males and 16 females, with a median age of 25.5 (range: from 17 to 60). Potential risk factors for perioperative complications and early failure in pectus repair were analysed with χ(2) test or Fisher's exact test and Mann-Whitney test. Potential risk factors for postoperative mid-term recurrence were analysed using Cox proportional hazard regression model. RESULTS The postoperative follow-up interval was 7.0 ± 15.1 months (mean ± standard deviation). No mortality and 11 patients (24.0%) of morbidity, including 2 patients with temporary mesh infection, were noted. A lower preoperative %FEV1.0 predicted was a significant factor (P = 0.0088) of morbidity in multivariate analysis. Regarding chest morphology, early failure in 1 patient (2.2%) and mid-term recurrence in 1 patient (2.2%) were seen. Previous pectus repair (P = 0.0324) and severe asymmetry (P = 0.04) were significant factors of early failure in multivariate analysis, while no significant factor for mid-term recurrence was found. CONCLUSIONS Modified Robicsek procedure with a polypropylene mesh is associated with low incidences of early failure and mid-term recurrence. The procedure is recommended for adult pectus excavatum patients, including those with asymmetric or combined deformity as an initial or reoperative procedure.
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Affiliation(s)
- Masatsugu Hamaji
- Division of General Thoracic Surgery, Mayo Clinic Rochester, Rochester, MN, USA
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Clinical Results and Patient Satisfaction after Pectus Excavatum Repair Using the MIRPE and MOVARPE Technique in Adults. Plast Reconstr Surg 2013; 132:1591-1602. [DOI: 10.1097/prs.0b013e3182a97dc1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Correction of pectus excavatum through a minimally invasive approach with subxyphoid incision and 3-point fixation. J Thorac Cardiovasc Surg 2013; 146:1294-6. [DOI: 10.1016/j.jtcvs.2013.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/02/2013] [Accepted: 07/08/2013] [Indexed: 11/20/2022]
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Muhammad MIA. Thoracoscopic repair of pectus excavatum using different bar stabilizers versus open repair. Asian Cardiovasc Thorac Ann 2013; 22:187-92. [DOI: 10.1177/0218492313487180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To identify the preoperative characteristics and compare operative variables and postoperative outcomes in adult patients with pectus excavatum undergoing thoracoscopic repair using different bar stabilizers or open surgical repair. Methods 31 patients were randomly divided into 3 groups: group A was 9 patients who underwent a modified Ravitch repair, group B was 11 patients who underwent video-assisted thoracoscopic repair using metal stabilizers, and group C was 11 patients who underwent video-assisted thoracoscopic repair using absorbable stabilizers. Preoperative, intraoperative, and postoperative variables and mortality were compared among groups. Results In all groups, preoperative variables were well-matched for age, sex, and Haller index. Operative time was significantly longer in group A. The postoperative length of hospital stay was significantly shorter in group A. Postoperative complications occurred in 7 (22.6%) patients, mostly in groups B and C. All patients were satisfied with the cosmetic result. Conclusions Repair of pectus excavatum in adult patients can be performed effectively either through an open surgical technique or thoracoscopy, with no intraoperative complications and excellent immediate results, but video-assisted thoracoscopic repair using metallic or absorbable bar stabilizers gives a better cosmetic result; however, absorbable bar stabilizers are more vulnerable and break more easily than metal stabilizers.
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Affiliation(s)
- Magdi Ibrahim Ahmad Muhammad
- Department of Cardio-Thoracic Surgery, Faculty of medicine, Suez Canal University, Egypt
- Department of Thoracic Surgery, King Fahad Hospital, Al-Madina Al-Munawara, Saudi Arabia
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Hanna WC, Ko MA, Blitz M, Shargall Y, Compeau CG. Thoracoscopic Nuss Procedure for Young Adults With Pectus Excavatum: Excellent Midterm Results and Patient Satisfaction. Ann Thorac Surg 2013; 96:1033-6; discussion 1037-8. [DOI: 10.1016/j.athoracsur.2013.04.093] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/15/2022]
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