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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; 59:161590. [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] [MESH Headings] [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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Donati F, Cipriani MS, Pistorio A, Guerriero V, Mattioli G, Torre M. Pectus Bar Dislocation: Comparison Between Three Different Stabilization Techniques Adopted in a Single Centre. J Pediatr Surg 2024; 59:161591. [PMID: 38914509 DOI: 10.1016/j.jpedsurg.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Bar dislocation has always been considered a fearsome complication of Minimally Invasive Repair of Pectus Excavatum (MIRPE), therefore multiple techniques and types of stabilization have been introduced. The aim of the study is to compare different stabilization techniques in a cohort of patients operated by the same first operator. METHODS MIRPE was adopted at our institution in 2005. Data on MIRPE patients from January 2013 to December 2022 were collected prospectively and reviewed. Patients with a follow-up of at least 12 months were included. Throughout the years different ways of stabilization were used. Patients were divided in 3 groups according to the stabilization strategy adopted- Group A: no stabilizer; Group B: single bar fixation; Group C: bridge fixation. Dislocation was diagnosed if a bar rotated more than 30° or displaced laterally for more than 1.5 cm. We compared bar dislocation percentage of each group. RESULTS We positioned 733 bars in 468 patients. Group A included 113 bars (15.4%), Group B 415 bars (56.6%), Group C 205 bars (28%). No patients were lost at follow-up. Total dislocation rate was 4.1% (30 bars). Dislocation was observed in 10 bars of group A (8.8%), 20 bars of group B (4.8 %), 0 bars of group C (0%). Differences between groups were statistically significant. CONCLUSIONS The use of stabilizers reduced dislocation percentage. In particular, bridge fixation technique reduced to zero bar dislocation and is now our preferred technique of stabilization. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Francesco Donati
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy.
| | - Maria Stella Cipriani
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy
| | - Angela Pistorio
- Scientific Directorate - Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy
| | - Vittorio Guerriero
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Michele Torre
- Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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Carter M, Hua R, Pitt JB, Zeineddin S, Perez A, Sands L, Kujawa S, Lehane A, Stake C, Reynolds M, Abdullah F, Goldstein SD. Utility of White Light Scanning as an Alternative to Computed Tomography to Evaluate Severity of Pectus Excavatum Deformity. J Pediatr Surg 2024; 59:1694-1702. [PMID: 38772759 DOI: 10.1016/j.jpedsurg.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Pectus excavatum (PE) severity and surgical candidacy are determined by computed tomography (CT)-delineated Haller Index (HI) and Correction Index (CI). White light scanning (WLS) has been proposed as a non-ionizing alternative. The purpose of this retrospective study is to create models to determine PE severity using WLS as a non-ionizing alternative to CT. METHODS Between November 2015 and February 2023, CT and WLS were performed for children ≤18 years undergoing evaluation at a high-volume, chest-wall deformity clinic. Separate quadratic discriminate analysis models were developed to predict CT HI ≥ 3.25 and CT CI ≥ 28% indicating surgical candidacy. Two bootstrap forest models were trained on WLS measurements and patient demographics to predict CT HI and CT CI values then compared to actual index values by intraclass correlation coefficient (ICC). RESULTS In total, 242 patients were enrolled (86.4% male, mean [SD] age 15.2 [1.3] years). Quadratic discriminate analysis models predicted CT HI ≥ 3.25 with specificity = 91.7%, PPV = 97.7% (AUC = 0.91), and CT CI ≥ 28% with specificity = 92.3%, PPV = 93.5% (AUC = 0.84). Bootstrap forest model predicted CT HI with training dataset ICC (95% CI) = 0.91 (0.88-0.93, R2 = 0.85) and test dataset ICC (95% CI) = 0.86 (0.71-0.94, R2 = 0.77). For CT CI, training dataset ICC (95% CI) = 0.91 (0.81-0.93, R2 = 0.86) and test dataset ICC (95% CI) = 0.75 (0.50-0.88, R2 = 0.63). CONCLUSIONS Using noninvasive and nonionizing WLS imaging, we can predict PE severity at surgical threshold with high specificity obviating the need for CT. Furthermore, we can predict actual CT HI and CI with moderate-excellent reliability. We anticipate this point-of-care tool to obviate the need for most cross-sectional imaging during surgical evaluation of PE. LEVEL OF EVIDENCE Level III. STUDY TYPE Study of Diagnostic Test.
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Affiliation(s)
- Michela Carter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
| | - Rui Hua
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Shirley Ryan AbilityLab, Chicago, IL, United States
| | - J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Amparo Perez
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Laurie Sands
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Suzanne Kujawa
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Alison Lehane
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Christine Stake
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Marleta Reynolds
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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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; 168:699-711. [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] [MESH Headings] [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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Tomašević O, Ivančić A, Mejić L, Lužanin Z, Jorgovanović N. Depth-Sensing-Based Algorithm for Chest Morphology Assessment in Children with Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2024; 24:5575. [PMID: 39275488 PMCID: PMC11398239 DOI: 10.3390/s24175575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024]
Abstract
This study introduced a depth-sensing-based approach with robust algorithms for tracking relative morphological changes in the chests of patients undergoing physical therapy. The problem that was addressed was the periodic change in morphological parameters induced by breathing, and since the recording was continuous, the parameters were extracted for the moments of maximum and minimum volumes of the chest (inspiration and expiration moments), and analyzed. The parameters were derived from morphological transverse cross-sections (CSs), which were extracted for the moments of maximal and minimal depth variations, and the reliability of the results was expressed through the coefficient of variation (CV) of the resulting curves. Across all subjects and levels of observed anatomy, the mean CV for CS depth values was smaller than 2%, and the mean CV of the CS area was smaller than 1%. To prove the reproducibility of measurements (extraction of morphological parameters), 10 subjects were recorded in two consecutive sessions with a short interval (2 weeks) where no changes in the monitored parameters were expected and statistical methods show that there was no statistically significant difference between the sessions, which confirms the reproducibility hypothesis. Additionally, based on the representative CSs for inspiration and expirations moments, chest mobility in quiet breathing was examined, and the statistical test showed no difference between the two sessions. The findings justify the proposed algorithm as a valuable tool for evaluating the impact of rehabilitation exercises on chest morphology.
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Affiliation(s)
- Olivera Tomašević
- Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
| | | | - Luka Mejić
- Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Zorana Lužanin
- Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nikola Jorgovanović
- Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
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Lukish A, Kovler M, Shah A, Gosztyla C, Lukish J. Simultaneous Bilateral Thoracoscopy During the Nuss Procedure is Safe, Effective and Allows for Optimal Visualization of the Bar Passer Throughout the Substernal Dissection. J Pediatr Surg 2024:161666. [PMID: 39217004 DOI: 10.1016/j.jpedsurg.2024.08.006] [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: 04/30/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Cardiac injury during the Nuss procedure is a rare risk that can lead to a catastrophic outcome. The specific aim of this pilot study was to evaluate the safety and efficacy of simultaneous bilateral thoracoscopy (SBT) compared to standard unilateral right thoracoscopy (RT) in children undergoing the Nuss procedure in order to mitigate that risk. METHODS IRB approval was obtained to analyze data on children who underwent SBT and RT during the Nuss procedure. Data retrieval included age, gender, Haller index (HI), operative time (OT), length of stay (LOS), complications and follow up. RESULTS From August 2022 to August 2023, 10 children who underwent SBT were compared to 10 children who underwent RT. Both groups underwent intercostal nerve cryoablation. Following completion of cryoablation, SBT or RT was carried out during the Nuss procedure. SBT allowed for the tip of the bar passer to be visualized during the entire dissection in both thoraces. There was no significant difference in either group with respect to age, HI, OT, LOS. There were no anesthetic or surgical complications in either group. CONCLUSION We found that SBT is safe, effective and allows for 100% visualization of the tip of the bar passer during the entire critical phase of the Nuss procedure. It does not impact OT or LOS compared to children who underwent only RT. SBT may benefit children who undergo the Nuss procedure by reducing the risk of cardiac injury. TYPE OF STUDY Original Research Retrospective Case-control study.
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Affiliation(s)
- Annamarie Lukish
- Kansas City University, School of Medicine and Biosciences, Kansas City, MO, USA
| | - Mark Kovler
- Division of Pediatric Surgery, Children's National Hospital, Washington, D.C, USA
| | - Adil Shah
- Division of Pediatric Surgery, Children's Nebraska, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Carolyn Gosztyla
- Division of Pediatric Surgery, Children's National Hospital, Washington, D.C, USA
| | - Jeffrey Lukish
- Division of Pediatric Surgery, Children's National Hospital, Washington, D.C, USA; Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, D.C, USA.
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Sanjurjo D, Toselli L, Gigena C, Bellia-Munzon G, Elmo G, Giacosa F, Vallee M, Martinez-Ferro M. Proposing the Retrosternal Angle as a Diagnostic Measure for Banana Sternum in Pectus Excavatum. J Pediatr Surg 2024:161667. [PMID: 39198134 DOI: 10.1016/j.jpedsurg.2024.08.007] [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: 04/30/2024] [Revised: 07/25/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND/PURPOSE Anteriorly convex sternum in pectus excavatum, also known as banana sternum (BS), influences decision-making during repair and, especially, the need to cross bars. However, the definition of BS remains subjective. Thus, we aim to propose the retrosternal angle (RSA) as a diagnostic measure for the discrimination of BS. MATERIAL AND METHODS Retrospective analysis of a cohort of patients who underwent a minimally invasive repair of pectus excavatum (MIRPE) between October 2016 and October 2023 at our Pectus Clinic. Five expert thoracic surgeons individually reviewed their medical photographs and chest CT scans assigning patients to BS or non-BS groups based on consensus (≥4 surgeons). RSA measurements were obtained by an independent thoracic surgeon. RESULTS Among 283 cases analyzed, 50 (18%) were classified as BS and 233 (82%) as non-BS. No significant differences were found between groups in age (p = 0.62), Haller index (p = 0.11), or Correction index (p = 0.58). However, RSA was significantly lower in the BS group (141.2 ± 8.4° vs. 154.5 ± 10.3°, p < 0.0001). Receiver operating characteristic curve analysis revealed RSA as a reliable predictor of BS (AUC 0.85, p < 0.0001), with a threshold of 148.5° demonstrating 80% sensitivity and 77% specificity. Regarding potential clinical implications, 26/50 (52%) of patients defined as BS underwent bar crossing, compared with 45/232 (19%) of those not considered a BS (p < 0.0001). CONCLUSION This study proposes an objective metric, the Retrosternal Angle, to assess BS in chest CT scans, with a threshold of 148.5° showing high sensitivity and specificity. External validation of this angle and threshold is warranted in future investigations. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniela Sanjurjo
- Fundacion Hospitalaria Mother and Child Medical Center. Av. Crámer 4601, Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Luzia Toselli
- Fundacion Hospitalaria Mother and Child Medical Center. Av. Crámer 4601, Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina.
| | - Cecilia Gigena
- Fundacion Hospitalaria Mother and Child Medical Center. Av. Crámer 4601, Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Gaston Bellia-Munzon
- Fundacion Hospitalaria Mother and Child Medical Center. Av. Crámer 4601, Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Gaston Elmo
- Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Facundo Giacosa
- Fundacion Hospitalaria Mother and Child Medical Center. Av. Crámer 4601, Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Maxroxia Vallee
- Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Marcelo Martinez-Ferro
- Fundacion Hospitalaria Mother and Child Medical Center. Av. Crámer 4601, Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina, Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
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Chen T, Xu Y, Chen Y, Chen S, Zhang Y. Analgesic Effectiveness of Truncal Plane Blocks in Patients Undergoing the Nuss Procedure: A Randomized Controlled Trial. Pain Ther 2024; 13:909-917. [PMID: 38888719 PMCID: PMC11255141 DOI: 10.1007/s40122-024-00627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Most patients undergoing the Nuss procedure reported moderate to severe pain after surgery. This study aimed to investigate the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) combined with transversus thoracic muscle plane (TTMP) block for relieving acute pain in patients undergoing the Nuss procedure. METHODS The enrolled patients in our study were allocated to either receive combined nerve blocks with ropivacaine (NB group) or saline (CON group). The primary outcome of this study was postoperative pain at 2, 4, 8, 16, 24, 36, and 48 h during rest and movement (coughing). Secondary outcomes included intraoperative dosage of remifentanil, the time to extubation and the length of stay in the post-anesthesia care unit (PACU), the total acetaminophen and codeine tablet consumption, time to first bowel movement, time to first flatus, opioid-related adverse events, and the length of hospital stay. RESULTS Patients in the NB group had significantly lower Numerical Rating Scale (NRS) pain scores compared with the CON group. The NB group required significantly less postoperative acetaminophen consumption and lower dosages of perioperative sufentanyl and remifentanil compared with the CON group. The length of stay in the PACU and time to extubation were significantly increased in the CON group compared with the NE group. Time to first bowel movement and time to first flatus were earlier in the NB group. But there were no significant differences between the groups in terms of the length of hospital stay and codeine tablet consumption. CONCLUSION Ultrasound-guided SAPB and TTMP blocks in patients undergoing the Nuss procedure could provide effective analgesia. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000038506).
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Affiliation(s)
- Tao Chen
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Yu Xu
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Yu Chen
- Department of Anesthesiology, Jiangxi Provincial Children's Hospital, 122 Yang Ming Road, Nanchang, 330006, Jiangxi, China
| | - Shibiao Chen
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Yang Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China.
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Carroll MK, Powell AW, Hardie WD, Foster KE, Zhang B, Garcia VF, Vieira Alves VP, Brown RL, Fleck RJ. Pectus excavatum: the effect of tricuspid valve compression on cardiac function. Pediatr Radiol 2024; 54:1462-1472. [PMID: 38980355 PMCID: PMC11324711 DOI: 10.1007/s00247-024-05971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Pectus excavatum (PE) is a common congenital chest wall deformity with various associated health concerns, including psychosocial impacts, academic challenges, and potential cardiopulmonary effects. OBJECTIVE This study aimed to investigate the cardiac consequences of right atrioventricular groove compression in PE using cardiac magnetic resonance imaging. MATERIALS AND METHODS A retrospective analysis was conducted on 661 patients with PE referred for evaluation. Patients were categorized into three groups based on the degree of right atrioventricular groove compression (no compression (NC), partial compression (PC), and complete compression(CC)). Chest wall indices were measured: pectus index (PI), depression index (DI), correction index (CI), and sternal torsion. RESULTS The study revealed significant differences in chest wall indices between the groups: PE, NC=4.15 ± 0.94, PC=4.93 ± 1.24, and CC=7.2 ± 4.01 (P<0.0001). Left ventricle ejection fraction (LVEF) showed no significant differences: LVEF, NC=58.72% ± 3.94, PC=58.49% ± 4.02, and CC=57.95% ± 3.92 (P=0.0984). Right ventricular ejection fraction (RVEF) demonstrated significant differences: RVEF, NC=55.2% ± 5.3, PC=53.8% ± 4.4, and CC=53.1% ± 4.8 (P≥0.0001). Notably, the tricuspid valve (TV) measurement on the four-chamber view decreased in patients with greater compression: NC=29.52 ± 4.6; PC=28.26 ± 4.8; and CC=24.74 ± 5.73 (P<0.0001). CONCLUSION This study provides valuable insights into the cardiac consequences of right atrioventricular groove compression in PE and lends further evidence of mild cardiac changes due to PE.
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Affiliation(s)
- Molly K Carroll
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam W Powell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William D Hardie
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karla E Foster
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Victor F Garcia
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Vinicius P Vieira Alves
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, 45229, OH, USA
| | - Rebeccah L Brown
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, 45229, OH, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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10
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Notrica DM, McMahon LE, Jaroszewski DE. Pectus Disorders: Excavatum, Carinatum and Arcuatum. Adv Pediatr 2024; 71:181-194. [PMID: 38944483 DOI: 10.1016/j.yapd.2024.05.001] [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: 07/01/2024]
Abstract
This article reviews pectus excavatum, carinatum, and arcuatum. Topics covered include etiology, epidemiology, associated syndromes, physiologic impact, workup, indications for treatment, surgical and nonsurgical therapy, results, complications, and emerging therapies. Pectus excavatum is an inward deformation of the sternum and/or anterior chest wall. Pectus carinatum is ether an outward protrusion or tilt of the sternum with potential psychological impact, but no demonstrated physiologic impact. Nonoperative compression bracing is successful in carinatum patients with chest wall flexibility who are compliant with a bracing program. Pectus arcuatum is an abnormally short, fully fused sternum with a high anterior protrusion.
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Affiliation(s)
- David M Notrica
- Phoenix Children's Division of Pediatric Surgery, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine Phoenix, Department of Child Health and Surgery, 475 N. 5th Street Phoenix, AZ 85004, USA; Mayo Clinic School of Medicine and Science, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Lisa E McMahon
- Phoenix Children's Division of Pediatric Surgery, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine Phoenix, Department of Child Health and Surgery, 475 N. 5th Street Phoenix, AZ 85004, USA; Mayo Clinic School of Medicine and Science, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Dawn E Jaroszewski
- Mayo Clinic School of Medicine and Science, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA; Mayo Clinic Arizona, Division of Thoracic Surgery, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA
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11
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Cruz-Centeno N, Fraser JA, Stewart S, Marlor DR, Oyetunji TA, St Peter SD. Long-Term Recurrence Rates and Patient Satisfaction after Repair of Pectus Excavatum. Eur J Pediatr Surg 2024; 34:333-337. [PMID: 37451288 DOI: 10.1055/a-2127-6133] [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] [Indexed: 07/18/2023]
Abstract
BACKGROUND Pectus excavatum deformities are usually repaired with a minimally invasive approach in which a metal bar is used to correct the chest wall abnormality. We aimed to evaluate long-term outcomes and patient satisfaction after surgical correction. METHODS Patients who underwent pectus excavatum repair and subsequent bar removal at a single tertiary care center from January 2000 to December 2020 were identified. A retrospective chart review was performed, and a telephone survey was conducted to evaluate perceived inward chest movement, need for surgeon reevaluation, surgical reintervention, and overall satisfaction. Data are presented as medians with interquartile ranges (IQRs) and frequencies with percentages. RESULTS A total of 583 patients were included. The survey response rate was 26.2% (n = 153). The respondents were predominantly male (80.4%, n = 123) with a median age at surgical correction of 14.9 years (IQR 12.9, 16.1) and a median Haller index (HI) of 3.8 (IQR 3.4, 4.5). Median time to bar removal was 2.9 years (IQR 2.5, 3.0) with a median age at removal of 17.7 years (IQR 15.5, 19.0). Median time from surgery to survey follow-up was 9.6 years (IRQ 5.0, 11.4) with respondents having a median age at follow-up of 25 years (IQR 22.0, 28.4). The satisfaction rate was 96.7% (n = 148) with a reintervention rate of 2.0% (n = 3). The perceived inward chest movement was 30.7% (n = 47) with 12.8% (n = 6) of those requesting surgical reevaluation. CONCLUSION There is a high level of satisfaction many years after correction of pectus excavatum and bar removal. With the advent of cryoablative therapy since 2017, patient satisfaction improved by experience of less postoperative pain. Reintervention rate is low despite some patients reporting a perceived chest wall inward movement.
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Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - James A Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Derek R Marlor
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
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12
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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.
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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
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13
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Wojtyś ME, Kordykiewicz D, Wójcik J, Tomos P, Kostopanagiotou K. Consultations for Poland Syndrome: The Essentials for a Thoracic Surgeon. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1178. [PMID: 39064607 PMCID: PMC11278914 DOI: 10.3390/medicina60071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Poland syndrome (PS) is a rare congenital musculoskeletal entity occurring in approximately 1 in 30,000 newborns that manifests with variable symbrachydactyly, ipsilateral costochondral deformities, an absence of pectoral muscles, and breast underdevelopment. These have potential impacts on social, somatic, and psychological functionality, often leading affected individuals to seek expert opinions on corrective surgery. Due to phenotypic variability, strict management guidelines are lacking, with treatment decisions often based on the specialist's personal experience rather than published evidence. Comprehensive imaging with CT and MRI with 3D reconstruction is crucial for providing a descriptive assessment of musculoskeletal defects. Management is multidisciplinary, involving thoracic, plastic, and pediatric surgeons and hand surgery specialists, as well as psychologists and developmental growth specialists. Surgery should achieve both structural and cosmetic correction to reverse the psychological and social impact and achieve patient satisfaction. We aim to provide thoracic surgeons the essential answers for sharing with affected adult individuals during consultations focusing on chest surgical correction.
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Affiliation(s)
- Małgorzata Edyta Wojtyś
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Dawid Kordykiewicz
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Periklis Tomos
- Department of Thoracic Surgery, “Attikon” University Hospital of Athens, 12462 Athens, Greece
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14
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Xu Z, Liang G, Luo C, Wu J, Lei B, Zheng S, Zeng X, Lu N, Qian J, Zhou T, Chen Y, Liu J, Liu G, Lan W, Lu Q, Lu L, Guo J, Zheng B, Yang N. Intraventricular Thrombosis and Pulmonary Embolism Post-Nuss Procedure: A Rare Case of Chronic Bar Displacement in a 16-Year-Old Patient. Chest 2024; 165:e163-e167. [PMID: 38852972 DOI: 10.1016/j.chest.2024.01.035] [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] [Received: 11/19/2023] [Revised: 01/07/2024] [Accepted: 01/20/2024] [Indexed: 06/11/2024] Open
Abstract
This novel report presents the first known case, to our knowledge, of a 16-year-old male patient who experienced intraventricular thrombosis and pulmonary embolism after a Nuss procedure for pectus excavatum, attributed to chronic bar displacement. Two years after the operation, the patient experienced post-exercise cough and hemoptysis, which led to his admission. Imaging revealed pulmonary embolism, thrombosis in the right ventricular outflow tract, and lung infiltrative lesions. We hypothesize that the chronic bar displacement led to its embedment in the right ventricle, resulting in thrombus formation, which subsequently contributed to partial pulmonary embolism. Surgery revealed the bars' intrusion into the right ventricle and lung. This case highlights the risk of severe complications from bar displacement in the Nuss procedure, which necessitates long-term follow-up evaluation, caution against strenuous activities after surgery, and use of thoracoscopic guidance during bar implantation and removal. It underscores the importance of vigilant evaluation for late-stage complications in patients with respiratory distress or thrombosis after a Nuss procedure.
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Affiliation(s)
- Zhanyu Xu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guanbiao Liang
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng Luo
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ji Wu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Binfeng Lei
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Sai Zheng
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaochun Zeng
- Department of Cardiothoracic Surgery, Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ning Lu
- Department of Cardiothoracic Surgery, Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Qian
- Department of Cardiothoracic Surgery, Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ting Zhou
- Department of Cardiothoracic Surgery, Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanhua Chen
- Department of Anesthesiology in Cardiovascular Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jumei Liu
- Department of Anesthesia Catheter Room, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guofeng Liu
- Department of Anesthesiology in Cardiovascular Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weijing Lan
- Department of Anesthesiology in Cardiovascular Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingqing Lu
- Department of Anesthesia Catheter Room, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Lu
- Department of Anesthesia Catheter Room, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianji Guo
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Baoshi Zheng
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Nuo Yang
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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15
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Frediani S, Corbi L, Pardi V, Aloi IP, Bertocchini A, Accinni A, Reali S, Schingo PMS, Inserra A. Case Report: Double Pectus Up in severe pectus excavatum, the new frontier of modified taulinoplasty. Front Pediatr 2024; 12:1399202. [PMID: 38827216 PMCID: PMC11140038 DOI: 10.3389/fped.2024.1399202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/26/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Pectus excavatum, also known as "sunken chest" or "funnel chest," is a congenital condition where the sternum caves inward, creating a noticeable depression in the chest. This deformity can range from mild to severe cases, and can affect appearance and lung and heart function. Treatment options vary depending on the severity of the condition and associated symptoms. A case study was conducted on three patients suffering from severe forms of pectus excavatum using modified taulinoplasty with two Pectus Up bars. Case description The patients were males, with an age of 15 years. Preoperatively, they underwent spirometry, an echocardiogram, and allergy tests. The procedure involved inserting two Pectus Up bars into the chest wall at the major sternal defect, allowing the implant to remain completely invisible. The procedure involved placing the sternal plate at the deepest point and anchored to the sternum with five self-tapping screws. The chest plate was then fixed to the bar using two screws. Discussion The use of Pectus Up was first reported in 2016 and has been a subject of scientific discussion and research. The double Pectus Up technique offers improved correction, increased stability, and reduced complications. However, it also presents challenges such as increased technical complexity and potential for prolonged operative times. Patient outcomes showed promising results in terms of short-term correction and long-term stability. The use of a double bar technique in the modified Taulinoplasty procedure is a key area of ongoing clinical research and innovation in pectus excavatum repair. Further studies will be needed, including more institutions that use this technique to validate our initial experience.
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Affiliation(s)
- Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Letizia Corbi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Simone Reali
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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16
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Aranda-Valderrama P, Greenberg RS, Vecchione TM, Finney AG, Prichett LM, Vanderhoek SM. Combined erector spinae plane block with surgical intercostal nerve cryoablation for Nuss procedure is associated with decreased opioid use and length of stay. Reg Anesth Pain Med 2024; 49:248-253. [PMID: 37407278 DOI: 10.1136/rapm-2023-104407] [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] [Received: 02/02/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Pain management for patients undergoing the Nuss procedure for treatment of pectus excavatum can be challenging. In an effort to improve pain management, our institution added bilateral single injection erector spinae plane (ESP) blocks to surgeon placed intercostal nerve cryoablation. We aimed to assess the efficacy of this practice change. METHODS Retrospective clinical data from a single academic medical center were evaluated. Due to an institutional change in clinical management, we were able to perform a before and after study. Twenty patients undergoing Nuss procedure who received bilateral ultrasound-guided single-shot T6 level ESP blocks and intercostal nerve cryoablation were compared with a historical control cohort of 20 patients who underwent Nuss procedure with intercostal nerve cryoablation alone. The primary outcome variables included postoperative pain scores, total hospital opioid use, and hospital length of stay. RESULTS Median total hospital intravenous morphine milligram equivalents was lower for the ESP group than for the control group (0.60 (IQR 0.35-0.88) vs 1.15 mg/kg (IQR 0.74-1.68), p<0.01). There was no difference in postoperative pain scores between the two groups. Mean hospital length of stay was 2.45 (SD 0.69) days for the control group and 1.95 (SD 0.69) days for the ESP group (p=0.03). No adverse events related to block placement were identified. CONCLUSIONS In a single-center academic practice, the addition of bilateral single injection ESP blocks at T6 to surgeon performed cryoablation reduced opioid consumption without a change in subjectively reported pain scores. The results from this pilot study can provide effect size estimates to guide the design of future randomized trials.
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Affiliation(s)
- Paola Aranda-Valderrama
- Division of Pediatric Anesthesia, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert S Greenberg
- Division of Pediatric Anesthesia, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tricia M Vecchione
- Division of Pediatric Anesthesia, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amanda G Finney
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura M Prichett
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samuel M Vanderhoek
- Division of Pediatric Anesthesia, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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17
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Alver S, Bidak M, Erdoğan C, Ciftci B. A Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesia in Minimally Invasive Pectus Excavatum Repair Surgery with a Video-Assisted Thoracic Surgery Technique: Case Report. A A Pract 2024; 18:e01773. [PMID: 38569154 DOI: 10.1213/xaa.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Video-assisted thoracic surgery (VATS) is currently used for the repair of pectus excavatum. Analgesia after thoracic surgery can be provided with nerve blocks, intravenous drugs, or neuraxial techniques. Serratus posterior superior intercostal plane block (SPSIPB) is a novel interfascial plane block and it is performed between the serratus posterior superior muscle and the intercostal muscles at the level of the second and third ribs. In this case, we present our successful analgesic experience with SPSIPB in a patient who underwent minimally invasive pectus excavatum repair with a VATS technique.
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Affiliation(s)
- Selçuk Alver
- From the Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
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18
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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.
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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
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19
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Park HJ, Rim G, Yoon SK. Recent Advancements in Pectus Surgery: Crane Lifting, Multiple-Bar Approach, Bridge Stabilization, and Sandwich Technique. J Pediatr Surg 2024; 59:640-647. [PMID: 38185539 DOI: 10.1016/j.jpedsurg.2023.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE The most recent procedure for pectus excavatum repair involves crane-powered entire chest wall remodeling, which employs crane lifting, multiple-bar approach, bridge stabilization, and sandwich techniques. This resulted in a paradigm shift in pectus deformity repair from merely lifting the sunken bone to remodeling the chest wall into normal anatomy. METHODS We analyzed 649 patients who underwent surgery for pectus excavatum or complex combined deformities between March 2018 and January 2022. A crane with sternal wiring or screwing was used to lift the chest wall without using the pectus bar turning power. Multiple bars with bridge connections were placed to eliminate bar displacement. Modified sandwich techniques were applied to relieve the lower coastal flare (flare-buster) and focal protuberance (magic string). RESULTS The mean age of the patients included in the study was 12.2 years (range: 3-45 years). A single bar was used for 202 patients until 2021. For the multiple-bar technique, parallel bars (n = 142), crossbars (n = 166), and crossbars plus upper horizontal bars (XI pattern; n = 139) were used. The overall complication rate was 6.2 %. There was no cases of bar displacement were observed, but other minor complications such as pneumothorax (n = 20, 3.1 %), pleural effusion (n = 7, 1.1 %), and wound infection (n = 5, 0.8 %) were detected. Three patients required reoperation (infection, two: hemorrhage, one). CONCLUSIONS The crane-powered entire chest wall remodeling technique improved the safety and comprehensiveness of the repair procedure. By incorporating bridge stabilization and the use of multiple bars, we effectively resolved the issues related to bar displacement and incomplete repair. TYPE OF STUDY Retrospective Cohort Study. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Hyung Joo Park
- Department of Thoracic Surgery, Gangnam Nanoori Hospital, Seoul, South Korea.
| | - Gongmin Rim
- Department of Thoracic Surgery, Gangnam Nanoori Hospital, Seoul, South Korea
| | - Seung Keun Yoon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Lim BY, I H, Lee C. Biomechanical Effectivity Evaluation of Single- and Double-Metal-Bar Methods with Rotation and Equilibrium Displacements in Nuss Procedure Simulations. Ann Biomed Eng 2024; 52:1067-1077. [PMID: 38302767 DOI: 10.1007/s10439-024-03441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/30/2023] [Indexed: 02/03/2024]
Abstract
Surgical treatment of the pectus excavatum has led to the introduction of the Nuss procedure, a minimally invasive surgical procedure that involves inserting a metal bar under the sternum through a small lateral thoracic incision. An additional metal bar was inserted in patients with pectus excavatum to improve the retention of the restored chest wall after the Nuss procedure. However, a need still exists to analyze the mechanistic advantages and disadvantages of the double-bar method owing to the increased surgical time and proficiency. The purpose of this study is to compare and evaluate the efficiency of single- and double-bar methods using rotational and equilibrium displacement simulations of the Nuss procedure. A finite-element model was constructed for two types of metal bars inserted into the chest wall. Boundary conditions for the rotation and equilibrium displacements were set for the metal bar. The anterior sternal translation, Haller index and maximum equivalent stress and strain owing to the behavior of the metal bar were estimated and compared with the single-bar method and postoperatively acquired patient data. The simulation results showed that the influences of the intercostal muscle and equilibrium after rotation displacement were significant. The stresses and strains were distributed across the two metal bars, and the upper-metal bar was heavily loaded. The double-bar method was advantageous regarding the load distribution effects of the two metal bars on the chest wall. However, mechanical assessments are also important because an excessive load is typically applied to the upper-metal bar.
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Affiliation(s)
- Beop-Yong Lim
- Department of Biomedical Engineering, Graduate School, and University Research Park, Pusan National University, Busan, 49241, Republic of Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Pusan National University, Busan, 49241, Republic of Korea
| | - Chiseung Lee
- Department of Biomedical Engineering, School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Pusan National University, Busan, 49241, Republic of Korea.
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21
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Frongia G, Seitz O, Chatzisideris S, Mastorakis A. Is pregnancy safe with an implanted pectus bar? An uneventful pregnancy with implanted pectus bar following correction of pectus excavatum. BMJ Case Rep 2024; 17:e255568. [PMID: 38553016 PMCID: PMC10982776 DOI: 10.1136/bcr-2023-255568] [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: 04/02/2024] Open
Abstract
Limited data are available on the implications on pregnancy following pectus bar implantation for correction of pectus excavatum (Nuss procedure), while the pectus bars are in place. Limited data is also available on long-term reproductive implications following pectus bar removal.Providers at times need to consider the necessity to counsel a woman desiring pectus excavatum correction and pregnancy whether to postpone one of the two in favour of the other.We present the case of a woman of reproductive age with an uneventful pregnancy and delivery while carrying an implanted pectus bar and subsequent uneventful pregnancy and delivery after bar removal.
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Affiliation(s)
- Giovanni Frongia
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
| | - Oliver Seitz
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
| | - Sideris Chatzisideris
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
| | - Avraam Mastorakis
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
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22
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Keong DE, Tzeng IS, Htut N, Fan YJ, Hsieh MS, Cheng YL. Impact of delayed removal of pectus bar on outcomes following Nuss repair: a retrospective analysis. J Cardiothorac Surg 2024; 19:160. [PMID: 38549167 PMCID: PMC10976664 DOI: 10.1186/s13019-024-02685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/24/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Usually, pectus bars are removed 3 years after the Nuss procedure in patients with pectus excavatum. However, the optimal timing for postoperative pectus bar removal remains undefined. Our study investigated the effects of delayed pectus bar removal after Nuss repairs. METHODS Retrospective data were collected on patients who underwent Nuss procedures for pectus excavatum and had their bars removed from August 2014 to December 2020. Patients with correction periods > 3 years were divided into group A (< 6 years) and group B (≥ 6 years). Propensity score matching was used to compare complications and radiological outcomes associated with bar removal. RESULTS Of the 542 patients who underwent bar removal, 451 (Group A: 419 patients, Group B: 32) had correction duration > 3 years. The average correction duration was 4.5 ± 1.4 years. After propensity score matching analysis, group B [median duration: 8.0 (6.0-16.2) years] exhibited significantly longer median operative times (85 vs. 55 min; P = 0.026), higher callus formation rates (68.8% vs. 46.9%; P = 0.029), and greater median intraoperative blood loss (35 vs. 10 mL; P = 0.017) than group A [median duration: 4.2 (3.0-5.9) years]. However, following bar removal, the groups showed no statistical differences in the surgical complication rates (group A: 6.3% vs. group B: 9.4%; P = 0.648) or median ratio of radiological improvement (an improvement on the Haller index on chest radiography; 21.0% vs. 22.2%; P = 0.308). CONCLUSIONS Delaying pectus bar removal after Nuss repair presents certain challenges but does not compromise overall outcomes. These findings suggest that a longer correction period may be unnecessary. However, further multicenter studies with long-term follow-up are warranted to assess long-term outcomes.
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Affiliation(s)
- Der-En Keong
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | | | - Nay Htut
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yu-Jiun Fan
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Min-Shiau Hsieh
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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23
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Janssen N, Daemen JHT, Franssen AJPM, van Polen EJ, van Roozendaal LM, Hulsewé KWE, Vissers Y, de Loos ER. Intercostal nerve cryoablation versus thoracic epidural analgesia for minimal invasive Nuss repair of pectus excavatum: a protocol for a randomised clinical trial (ICE trial). BMJ Open 2024; 14:e081392. [PMID: 38531584 DOI: 10.1136/bmjopen-2023-081392] [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] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Epidural analgesia is currently considered the gold standard in postoperative pain management for the minimally invasive Nuss procedure for pectus excavatum. Alternative analgesic strategies (eg, patient-controlled analgesia and paravertebral nerve block) fail in accomplishing adequate prolonged pain management. Furthermore, the continuous use of opioids, often prescribed in addition to all pain management strategies, comes with side effects. Intercostal nerve cryoablation seems a promising novel technique. Hence, the primary objective of this study is to determine the impact of intercostal nerve cryoablation on postoperative length of hospital stay compared with standard pain management of young pectus excavatum patients treated with the minimally invasive Nuss procedure. METHODS AND ANALYSIS This study protocol is designed for a single centre, prospective, unblinded, randomised clinical trial. Intercostal nerve cryoablation will be compared with thoracic epidural analgesia in 50 young pectus excavatum patients (ie, 12-24 years of age) treated with the minimally invasive Nuss procedure. Block randomisation, including stratification based on age (12-16 years and 17-24 years) and sex, with an allocation ratio of 1:1 will be performed.Postoperative length of hospital stay will be recorded as the primary outcome. Secondary outcomes include (1) pain intensity, (2) operative time, (3) opioid usage, (4) complications, including neuropathic pain, (5) creatine kinase activity, (6) intensive care unit admissions, (7) readmissions, (8) postoperative mobility, (9) health-related quality of life, (10) days to return to work/school, (11) number of postoperative outpatient visits and (12) hospital costs. ETHICS AND DISSEMINATION This protocol has been approved by the local Medical Ethics Review Committee, METC Zuyderland and Zuyd University of Applied Sciences. Participation in this study will be voluntary and informed consent will be obtained. Regardless of the outcome, the results will be disseminated through a peer-reviewed international medical journal. TRIAL REGISTRATION NUMBER NCT05731973.
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Affiliation(s)
- Nicky Janssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Aimée J P M Franssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Elise J van Polen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Lori M van Roozendaal
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Yvonne Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
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Lei W, Shao M, Hu Y, Cao J, Han W, Wang R, Fei Q, Zou J, Yi J, Cheng Z, Liu W. Vacuum bell therapy for pectus excavatum: a retrospective study. BMC Pediatr 2024; 24:173. [PMID: 38461230 PMCID: PMC10924398 DOI: 10.1186/s12887-024-04615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/02/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Pectus excavatum, the most common chest wall deformity, is frequently treated with Nuss procedure. Here we will describe non-invasive procedure and analyze the variables associated vacuum bell therapy for patients with pectus excavatum. METHODS Retrospective case-control study in a single center between July 2018 and February 2022, including patients with pectus excavatum treated with vacuum bell. Follow-up was continued to September 2022. The Haller index and Correction index was calculated before and after treatment to analysis the effectiveness of vacuum bell therapy. RESULTS There were 98 patients enrolled in the treatment group, with 72 available for analysis, and the follow-up period ranged from 1.1 to 4.4 years (mean 3.3 years). When analyzing with the Haller Index, 18 patients (25.0%) showed excellent correction, 13 patients (18.1%) achieved good correction, and 4 patients (5.6%) had fair correction. The remaining patients had a poor outcome. Characteristics predicting a non-poor prognosis included initial age ≤ 11 years (OR = 3.94, p = 0.013) and patients with use over 24 consecutive months (OR = 3.95, p = 0.013). A total of 9 patients (12.5%) achieved a CI reduction below 10. Patients who started vacuum bell therapy at age > 11 had significantly less change compared to those who started at age ≤ 11 (P < 0.05). Complications included chest pain (5.6%), swollen skin (6.9%), chest tightness (1.4%) and erythema (15.3%). CONCLUSIONS A certain percentage of patients with pectus excavatum can achieve excellent correction when treated with pectus excavatum therapy. Variables predicting better outcome including initial age ≤ 11 years both in HI and CI and vacuum bell use over 24 consecutive months in HI. In summary, pectus excavatum is an emerging non-invasive therapy for pectus excavatum and will be widely performed in a certain group of patients.
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Affiliation(s)
- Weixuan Lei
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mengqi Shao
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yan Hu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jieming Cao
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wei Han
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ruoyao Wang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Quanming Fei
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jian Zou
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Junqi Yi
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zheyu Cheng
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenliang Liu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, China.
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.
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25
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Chu CC, Chang JW, Yang HH, Kuo FC, Tsai HL. Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience. J Chin Med Assoc 2024; 87:314-319. [PMID: 38224231 DOI: 10.1097/jcma.0000000000001054] [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] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND We aimed to assess the effectiveness of the Nuss procedure for pectus excavatum (PE) and explore the impacts of sex and age on outcomes. METHODS We retrospectively reviewed 594 consecutive children ≤18 years of age who underwent the thoracoscopy-assisted Nuss technique between January 2006 and July 2019. The severity of pectus deformity was calculated according to the Haller index (HI). The classification of PE and clinical data including complications was analyzed. RESULTS Of the 594 patients, 456 (76.8%) were boys and 138 (23.2%) were girls. The mean age at surgery was 10.0 ± 5.0 years. The most common types of PE were 1A and 2A2 according to Park classification. Intraoperative and postoperative complication rates were 2/594 (0.3%) and 74/594 (12.5%), respectively. The most common complication was bar displacement. The bar was removed in 414 patients 3.5 ± 0.8 years later. The mean preoperative HI, postoperative HI with bar, and HI after bar removal were 4.2 ± 1.7, 2.4 ± 0.3, and 2.7 ± 0.5, respectively. Compared to the preoperative HI, both the postoperative HI with bar and HI after bar removal were significantly lower ( p < 0.001). For preschool-age children, the preoperative HI was significantly higher ( p = 0.027) and the change in HI significantly improved compared to school-age children ( p = 0.004). Boys and adolescents needed significantly more bars and stabilizers. CONCLUSION Surgical correction of PE using the Nuss procedure is a safe procedure and improves the HI in children of different ages, even in those younger than 6 years of age.
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Affiliation(s)
- Chih-Chun Chu
- Department of Surgery, Country Hospital, Taipei, Taiwan, ROC
- Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Jei-Wen Chang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hui-Hsin Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fang-Cheng Kuo
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Lin Tsai
- Department of Surgery, Country Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Htut N, Tzeng IS, Fan YJ, Cheng YL. Body measurement changes in adults with pectus excavatum after the Nuss procedure: a study of 272 patients. J Cardiothorac Surg 2024; 19:65. [PMID: 38321519 PMCID: PMC10845464 DOI: 10.1186/s13019-024-02573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Pectus excavatum (PE) is the most common congenital abnormality of the chest wall. Most patients with PE have slim bodies. Some studies have been conducted on the physical growth of children and adolescents who underwent the Nuss procedure. This study aimed to evaluate body measurement changes in adult patients with PE after the Nuss procedure. METHODS A total of 272 adult PE patients, who underwent the Nuss procedure and pectus bars removal from August 2014 to December 2020, were evaluated retrospectively. Body measurement [body height (BH), body weight (BW), and body mass index (BMI)] of the patients were collected before Nuss repair and after bar removal. We used the interquartile range (IQR) to identify and exclude outliers. Associations between changes in body measurement and clinical and radiological features were evaluated. RESULTS The BH, BW and BMI showed significantly increased after pectus bar removal, compared to pre-Nuss procedure parameters (BH 173.8 ± 5.9 cm vs. 173.9 ± 5.9 cm, P < 0.001; BW 60.3 ± 8.1 kg vs. 61.1 ± 8.8 kg, P = 0.005; BMI 19.9 ± 2.2 kg/m2 vs. 20.1 ± 2.4 kg/m2, P = 0.02). The same result were observed in the male subgroup, the HI ≥ 4 group and the male subgroup within the HI ≥ 4 group. CONCLUSIONS The BH, BW and BMI were significantly increased after completing surgical correction of PE using the Nuss procedure, particularly in young males and patients with more pronounced deformities.
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Affiliation(s)
- Nay Htut
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Statistics, National Taipei University, New Taipei City, Taiwan
| | - Yu-Jiun Fan
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Kwong JZ, Gulack BC. Non-surgical approaches to the management of chest wall deformities. Semin Pediatr Surg 2024; 33:151388. [PMID: 38219537 DOI: 10.1016/j.sempedsurg.2024.151388] [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: 01/16/2024]
Abstract
Chest wall deformities in children encompass a broad spectrum of disorders but pectus excavatum and carinatum are by far the most common. Treatment varies substantially by center, and depends on patient symptoms, severity of disease, and surgeon preference. Historically, surgical approaches were the mainstay of treatment for these disease processes but new advances in non-surgical approaches have demonstrated reasonable results in select patients. These non-surgical approaches include vacuum bell therapy, autologous fat grafting and hyaluronic acid injections for pectus excavatum, and orthotic brace therapy for pectus carinatum. There is debate with regards to optimal patient selection for these non-surgical approaches, as well as other barriers including reimbursement issues. This paper will review the current non-surgical approaches to chest wall deformities available, including optimal patient selection, treatment protocols, indications, contraindications, and outcomes.
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Affiliation(s)
- Jacky Z Kwong
- General Surgery Resident, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian Ch Gulack
- General Surgery Resident, Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
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Frediani S, Beati F, Pardi V, Aloi IP, Bertocchini A, Accinni A, Reali S, Schingo PMS, Inserra A. Case Report: Modified Taulinoplasty: a new technique for minimally invasive repair of pectus excavatum. Front Surg 2024; 10:1343515. [PMID: 38283062 PMCID: PMC10811093 DOI: 10.3389/fsurg.2023.1343515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction About 95% of congenital chest wall deformities are pectus abnormalities, with pectus excavatum (PE) being the most common. The purpose of this work is to offer a modified Taulinoplasty Technique based on 35 consecutive PE patients' 1-year single-center experience in 2022. Technique One minimally invasive procedure for PE is taulinoplasty. In order to prevent invasion of the mediastinum or pleural cavity, it is considered that external traction can be used to raise the sternum. Our experience indicates that the most common surgical consequences of this procedure-which involves creating a submuscular and subcutaneous tunnel to install the metal device-are post-operative seroma and wound dehiscence. We modified the conventional method to achieve more aesthetically pleasing results. Discussion Taulinoplasty seems to be a safe technique, easier and more feasible than standard Taulinoplasty, with better outcomes in terms of surgical complications, although further experience is necessary to confirm our preliminary data.
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Affiliation(s)
- Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federico Beati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Simone Reali
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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29
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Cheng YL. Editorial: Insights in the minimally invasive surgery for the repair of pectus excavatum. Front Surg 2024; 10:1334043. [PMID: 38239661 PMCID: PMC10794722 DOI: 10.3389/fsurg.2023.1334043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Yeung-Leung Cheng
- Department of Surgery, Taipei Tzu-Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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30
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Jarosz M, Pawlak K, Jarosz W, Wiernicka M, Barinow-Wojewódzki A, Stemplewski R. The effect of surgical repair of the chest on postural stability among patients with pectus excavatum. Sci Rep 2024; 14:45. [PMID: 38167457 PMCID: PMC10762140 DOI: 10.1038/s41598-023-50645-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
Pectus excavatum is the most encountered of chest wall deformities. It may produce respiratory and cardiovascular symptoms, hence surgical repair of this defect is performed. The procedure involving the insertion of metal bars under the sternum (the Nuss procedure) usually brings significant improvement to patients. However, the effect of the repair on the postural stability of patients has not been studied so far. To investigate the problem of patients' stability in the postoperative period male patients with pectus excavatum (n = 21) and healthy controls (n = 22) were included in the study. Using posturography methods, we showed a negative impact of the pectus excavatum repair surgery on patients' postural stability in the first postoperative phase. The centre of pressure displacement parameters used to measure postural stability were lower after the repair for both, the frontal and sagittal plane as well as for the velocity of displacements in the sagittal plane in the double stance with eyes open. Poorer postural stability was also found in patients with pectus excavatum when compared to healthy controls. Our findings may be useful for functional monitoring in the evaluation and surgical management of pectus excavatum patients and also when designing the rehabilitation of patients undergoing the Nuss procedure.
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Affiliation(s)
- Maria Jarosz
- Doctoral School, Poznań University of Physical Education, 27/39 Królowej Jadwigi Street, 61-871, Poznan, Poland.
| | - Krystian Pawlak
- Wielkopolska Center of Pulmonology and Thoracic Surgery, 62 Szamarzewskiego Street, 60-569, Poznan, Poland
| | - Wojciech Jarosz
- Department of Medical Biology, Poznań University of Physical Education, 27/39 Królowej Jadwigi Street, 61-871, Poznan, Poland.
| | - Marzena Wiernicka
- Department of Musculoskeletal Rehabilitation, Poznań University of Physical Education, 27/39 Królowej Jadwigi Street, 61-871, Poznan, Poland
| | | | - Rafał Stemplewski
- Department of Digital Technologies in Physical Activity, Poznań University of Physical Education, 27/39 Królowej Jadwigi Street, 61-871, Poznan, Poland
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Tekinbaş C, Bayraklı ZO. Overview of chest wall deformities. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S78-S88. [PMID: 38584783 PMCID: PMC10995686 DOI: 10.5606/tgkdc.dergisi.2024.25899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 04/09/2024]
Abstract
Chest wall deformities are congenital disorders characterized by abnormal development and appearance of the thoracic wall. The most common form is the pectus excavatum deformity, known as shoemaker's chest. Pectus carinatum, known as pigeon chest, is the second most common deformity. In general, most patients are asymptomatic, but cardiopulmonary problems may accompany the disease. The indication for treatment is mostly cosmetic. Treating patients before they reach adulthood increases the chance of success. Surgical treatment can be open or minimally invasive.
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Affiliation(s)
- Celal Tekinbaş
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Zeki Oğuzhan Bayraklı
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
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Farina JM, Yinadsawaphan T, Jaroszewski DE, Aly MR, Botros M, Cheema KP, Fatunde OA, Sorajja D. The electrocardiographic manifestations of pectus excavatum before and after surgical correction. J Electrocardiol 2024; 82:19-26. [PMID: 38000149 DOI: 10.1016/j.jelectrocard.2023.11.007] [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] [Received: 09/13/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Pectus excavatum (PEx) can cause cardiopulmonary limitations due to cardiac compression and displacement. There is limited data on electrocardiogram (ECG) alterations before and after PEx surgical repair, and ECG findings suggesting cardiopulmonary limitations have not been reported. The aim of this study is to explore ECG manifestations of PEx before and after surgery including associations with exercise capacity. METHODS A retrospective review of PEx patients who underwent primary repair was performed. ECGs before and after surgical correction were evaluated and the associations between preoperative ECG abnormalities and cardiopulmonary function were investigated. RESULTS In total, 310 patients were included (mean age 35.1 ± 11.6 years). Preoperative ECG findings included a predominant negative P wave morphology in V1, and this abnormal pattern significantly decreased from 86.9% to 57.4% (p < 0.001) postoperatively. The presence of abnormal P wave amplitude in lead II (>2.5 mm) significantly decreased from 7.1% to 1.6% postoperatively (p < 0.001). Right bundle branch block (RBBB) (9.4% versus 3.9%, p < 0.001), rsr' patterns (40.6% versus 12.9%, p < 0.001), and T wave inversion in leads V1-V3 (62.3% vs 37.7%, p < 0.001) were observed less frequently after surgery. Preoperative presence of RBBB (OR = 4.8; 95%CI 1.1-21.6) and T wave inversion in leads V1-3 (OR = 2.3; 95%CI 1.3-4.2) were associated with abnormal results in cardiopulmonary exercise testings. CONCLUSION Electrocardiographic abnormalities in PEx are frequent and can revert to normal following surgery. Preoperative RBBB and T wave inversion in leads V1-3 suggested a reduction in exercise capacity, serving as a marker for the need for further cardiovascular evaluation of these patients.
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Affiliation(s)
- Juan M Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA; Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Dawn E Jaroszewski
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Mohamed R Aly
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Michael Botros
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Kamal P Cheema
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
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Deol PK, Hoover JD, Phillips JD. Use of Transesophageal Echocardiography for Enhanced Safety During Bar Removal Procedures After Minimally Invasive Repair of Pectus Excavatum. J Laparoendosc Adv Surg Tech A 2023; 33:1218-1222. [PMID: 37844062 DOI: 10.1089/lap.2022.0410] [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: 10/18/2023] Open
Abstract
Background: Minimally invasive repair of pectus excavatum involves placement of retrosternal support (Nuss) bars. Hardware removal has been rarely associated with life-threatening hemorrhage from the heart, aorta, internal mammary arteries, and/or lung. There is no accepted standard intraoperative monitoring technique used during removal. We hypothesized that the use of transesophageal echocardiography (TEE) during Nuss bar removal would enhance safety of the procedure and be cost-effective. Methods: IRB-approved retrospective review of patients who underwent Nuss bar removal with intraoperative TEE monitoring over a 4-year period, from March 2013 to May 2017, was completed. Bar removal procedures were performed supine, under general anesthesia. TEE images were monitored and any distortion of the cardiac silhouette, new pericardial effusion, and/or cardiac arrhythmias would be considered evidence of possible bar adherence, triggering possible conversion to sternotomy or thoracotomy. Results: In total, 87 consecutive patients, mean age of 20 years, were identified. Bars had been in place for a mean of 30 months. Average procedure time was 67 minutes. No patients experienced arrhythmias, cardiac injury, or significant hemorrhage during removal. TEE gave excellent visualization of the cardiac silhouette and pericardium in all cases. No patient required insertion of an arterial line, a postoperative chest X-ray, or overnight hospitalization. Patients were discharged from the recovery room an average of 89 minutes postprocedure. Conclusion: TEE offers a minimally invasive safe way to visualize the pericardium and its contents during Nuss bar removal. Significant cardiac/mediastinal injuries should be immediately visible. The use of TEE is cost-effective and allows safe discharge the day of surgery.
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Affiliation(s)
- Preeya K Deol
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J David Hoover
- WakeMed Health and Hospitals, Pediatric Surgery, Raleigh, North Carolina, USA
| | - J Duncan Phillips
- WakeMed Health and Hospitals, Pediatric Surgery, Raleigh, North Carolina, USA
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Lim BY, Ryu D, I H, Lee C. A novel in silico Nuss procedure for pectus excavatum patients. Phys Eng Sci Med 2023; 46:1629-1642. [PMID: 37695510 PMCID: PMC10703950 DOI: 10.1007/s13246-023-01325-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
The purpose of this study is to suggest a novel in silico Nuss procedure that can predict the results of chest wall deformity correction. Three-dimensional (3D) geometric and finite element model of the chest wall were built from the 15-year-old male adolescent patient's computed tomography (CT) image with pectus excavatum of the mild deformity. A simulation of anterior translating the metal bar (T) and a simulation of maintaining equilibrium after 180-degree rotation (RE) were performed respectively. A RE simulation using the chest wall finite element model with intercostal muscles (REM) was also performed. Finally, the quantitative results of each in silico Nuss procedure were compared with those of postoperative patient. Furthermore, various mechanical indicators were compared between simulations. This confirmed that the REM simulation results were most similar to the actual patient's results. Through two clinical indicators that can be compared with postoperative patient and mechanical indicators, the authors consider that the REM of silico Nuss procedure proposed in this study is best simulated the actual surgery.
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Affiliation(s)
- Beop-Yong Lim
- Department of Biomedical Engineering, Gradate School, and University Research Park, Pusan National University, Busan, 49241, Republic of Korea
| | - Dongman Ryu
- Medical Research Institute, Pusan National University, Busan, 49241, Republic of Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Biomedical Research Institute, Pusan National University, Pusan National University Hospital, Busan, 49241, Republic of Korea.
| | - Chiseung Lee
- Department of Biomedical Engineering, School of Medicine, Biomedical Research Institute, Pusan National University, Pusan National University Hospital, Busan, 49241, Republic of Korea.
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Talsma J, Kusakavitch M, Lee D, Niederhauser C, Palmer B, Ozgediz D, Idowu O, Kim S. Forgotten Branch of the Intercostal Nerve: Implication for Cryoablation Nerve Block for Pectus Excavatum Repair. J Pediatr Surg 2023; 58:2435-2440. [PMID: 37286412 DOI: 10.1016/j.jpedsurg.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND We first utilized and reported on the use of cryoanalgesia for postoperative pain control for Nuss procedure in 2016. We hypothesized that postoperative pain control could be optimized if the intercostal nerve anatomy is better understood. To test this hypothesis, human cadavers were dissected to elucidate the intercostal nerve anatomy. Cryoablation technique was modified. METHODS Cadaver Study: Adult cadavers were used to visualize the branching patterns of the intercostal nerves. Cryoablation: Posterior to the mid-axillary line for intercostal nerves 4, 5, 6 and 7, main intercostal nerve, lateral cutaneous branch and collateral branch were cryoablated under thoracoscopic view. Verbal pain scores were obtained from patients one day after the procedure. RESULTS The study results were obtained during the years 2021 and 2022. Eleven cadavers were dissected. The path of the main intercostal and lateral cutaneous branch lie on the inferior rib surface of the corresponding intercostal nerve. Total of 92 lateral cutaneous branches of the intercostal nerve were dissected and measured as they pierced the intercostal muscle. Most lateral cutaneous branches of the intercostal nerve pierced the intercostal muscle anterior to midaxillary line 78.3%, posterior to midaxillary line 18.5% or on the midaxillary line 3.3%. The collateral branch of the intercostal nerve separated near the spine and traveled along the superior surface of the next inferior rib. Cryoablation: 22 male patients underwent Nuss procedure with cryoanalgesia. Median age of the patients was 15 years (IQR: 2), median Haller index was 3.73 (IQR: 0.85), median pain score (0-10 maximum pain) was 1 (IQR: 1.75). CONCLUSION Cryoablation of the intercostal nerve and its two branches improves pain control after a Nuss procedure. LEVEL OF EVIDENCE Level 4. TYPE OF STUDY Observational study.
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Affiliation(s)
- Joel Talsma
- University of New England, College of Osteopathic Medicine, Biddeford, ME, USA
| | - Melanie Kusakavitch
- University of New England, College of Osteopathic Medicine, Biddeford, ME, USA
| | - Dawon Lee
- University of New England, College of Osteopathic Medicine, Biddeford, ME, USA
| | | | - Barnard Palmer
- University of California San Francisco, San Francisco, CA, USA
| | - Doruk Ozgediz
- University of California San Francisco, Benioff Children's Hospitals, Oakland, San Francisco, CA, USA
| | - Olajire Idowu
- University of California San Francisco, Benioff Children's Hospitals, Oakland, San Francisco, CA, USA
| | - Sunghoon Kim
- University of California San Francisco, Benioff Children's Hospitals, Oakland, San Francisco, CA, USA.
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Lim BY, I H, Lee C. Biomechanical validation of novel Nuss procedure simulations for patients with various morphological types of pectus excavatum. Front Bioeng Biotechnol 2023; 11:1297420. [PMID: 38026863 PMCID: PMC10667684 DOI: 10.3389/fbioe.2023.1297420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
A novel Nuss procedure simulation was developed for patients with pectus excavatum considering the displacement of a metal bar and a chest wall model, including the intercostal muscles. However, this simulation was developed for a typical symmetrical patient among the various morphological types of pectus excavatum. Accordingly, this study aimed to validate and confirm the novel simulation for patients with eccentric and imbalanced types, which are severe types of pectus excavatum, considering factors such as depression depth and eccentricity among others. Three-dimensional models of chest walls and metal bars were created for three different types of patients. The rotation-equilibrium displacement and chest wall with intercostal muscles were set according to the methods and conditions of the novel Nuss procedure simulation. The anterior sternal translation and the Haller index derived from the simulation results were compared and verified using medical data from actual postoperative patients. Additionally, maximum equivalent stresses and strains were derived to confirm the suitability of the novel Nuss procedure for each patient type. The severe types had similar precision to the typical type when compared to the actual postoperative patient. Relatively high maximum equivalent stresses and strains were observed on the metal bars and sternum in the severe type, thereby predicting and confirming the biomechanical characteristics of these types. In conclusion, a novel Nuss procedure simulation for severe types was numerically validated. This underscores the importance of biomechanical evaluation through a novel Nuss procedure simulation when planning actual surgeries for severe types of cases.
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Affiliation(s)
- Beop-Yong Lim
- Department of Biomedical Engineering, Graduate School and University Research Park, Pusan National University, Busan, Republic of Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Chiseung Lee
- Department of Biomedical Engineering, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Sargent B, Bolanos D, Garcia V, Howell L. An Aggregate Sternal Force-Deflection Model. J Biomech Eng 2023; 145:111009. [PMID: 37565991 DOI: 10.1115/1.4063148] [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] [Received: 12/16/2022] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
Understanding the force-deflection behavior of the sternum is an important element in designing devices for implants for chest wall deformity repair. Human growth and variability makes a single measure of the stiffness difficult to determine. This work takes empirical data from the literature to develop aggregate sternal force-deflection models. Statistical methods were used to determine possible groupings based on patient age and the effect of gender. It was found that three age groups could be used, representing childhood (4-10 years), adolescence (11-19 years), and adulthood (26-53 years). Gender was found to have a statistical p-value of 0.068, 0.0611, and 0.012, respectively, in the proposed age groups. Jittering of the data was used to account for human variability and assumptions made in data comparisons. The jittered results followed that of the initial dataset. Childhood force-deflection behavior follows a relatively constant stiffness, adolescence experiences a growth period of increasing stiffness, and adulthood stiffnesses again begin to stabilize around a relatively constant value.
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Affiliation(s)
- Brandon Sargent
- Department of Mechanical Engineering, Gonzaga University, Spokane, WA 99258
| | - Diana Bolanos
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
| | - Victor Garcia
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229
| | - Larry Howell
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
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Breglio AM, Fitzgerald TN, Moore CB, Einhorn LM. Evaluation of Analgesic Practice Changes Following the Nuss Procedure in Pediatric Patients. J Surg Res 2023; 291:289-295. [PMID: 37481964 PMCID: PMC10528185 DOI: 10.1016/j.jss.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Pectus excavatum repair by the Nuss procedure results in severe postoperative pain. Regional blocks and intercostal nerve cryoablation (INC) have emerged as potential strategies to manage analgesia. This study compares pain-related outcomes following these perioperative interventions. METHODS We reviewed charts of patients <18 y who underwent the Nuss procedure at Duke Children's Hospital from July 2018 to June 2022. Patients were divided into three groups by analgesic strategy: no block, regional catheters, or INC, representing the chronologic change in our practice. The primary outcome was total and daily in-hospital opioid utilization measured by oral morphine equivalents (OMEs). Secondary outcomes included average daily pain scores, length of stay, opioid refills after discharge, and complications. RESULTS Twenty-one patients were included and analyzed: no block (n = 6), regional catheters (n = 7), and INC (n = 8). INC-treated patients required significantly lower total postoperative, in-hospital OMEs (64 ± 47 [mean ± standard deviation]) than those with no block (270 ± 217, P = 0.04) or those with regional catheters (273 ± 176, P = 0.03). INC was associated with longer average operative times (161 ± 36 min) than no block (105 ± 21 min, P = 0.005) or regional catheters (90 ± 11 min, P < 0.001). INC-treated patients had shorter hospital length of stays (median 68 h) than those with regional catheters (median 74 h, P = 0.006). CONCLUSIONS INC was associated with longer operative times but decreased in-hospital OMEs when compared to bilateral regional block catheters and multimodal analgesia alone.
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Affiliation(s)
- Andrew M Breglio
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Carrie B Moore
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Lisa M Einhorn
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
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Mehl SC, Sun RC, Anbarasu CR, Portuondo JI, Espinoza AF, Whitlock RS, Shah SR, Nuchtern JG, Minifee PK, Rodriguez JR, Le LD, Stafford SJ, Mazziotti MV. Association of Intercostal Nerve Cryoablation During Nuss Procedure With Complications and Costs. Ann Thorac Surg 2023; 116:803-809. [PMID: 35489402 DOI: 10.1016/j.athoracsur.2022.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intercostal nerve cryoablation with the Nuss procedure has been shown to decrease opioid requirements and hospital length of stay; however, few studies have evaluated the impact on complications and hospital costs. METHODS A retrospective cohort study was performed for all Nuss procedures at our institution from 2016 through 2020. Outcomes were compared across 4 pain modalities: cryoablation with standardized pain regimen (n = 98), patient-controlled analgesia (PCA; n = 96), epidural (n = 36), and PCA with peripheral nerve block (PNB; n = 35). Outcomes collected included length of stay, opioid use, variable direct costs, and postoperative complications. Univariate and multivariate hierarchical regression analysis was used to compare outcomes between the pain modalities. RESULTS Cryoablation was associated with increased total hospital cost compared with PCA (cryoablation, $11 145; PCA, $8975; P < .01), but not when compared with epidural ($9678) or PCA with PNB ($10 303). The primary driver for increased costs was operating room supplies (PCA, $2741; epidural, $2767; PCA with PNB, $3157; and cryoablation, $5938; P < .01). With multivariate analysis, cryoablation was associated with decreased length of stay (-1.94; 95% CI, -2.30 to -1.57), opioid use during hospitalization (-3.54; 95% CI, -4.81 to -2.28), and urinary retention (0.13; 95% CI, 0.05-0.35). CONCLUSIONS Cryoablation significantly reduces opioid requirements and length of stay relative to alternative modalities, but it was associated with an increase in total hospital costs relative to PCA, but not epidural or PCA with PNB. Cryoablation was not associated with allodynia or slipped bars requiring reoperation.
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Affiliation(s)
- Steven C Mehl
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.
| | - Raphael C Sun
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | | | | | - Andres F Espinoza
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | | | - Sohail R Shah
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Jed G Nuchtern
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Paul K Minifee
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - J Ruben Rodriguez
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Louis D Le
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Shawn J Stafford
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Mark V Mazziotti
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
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Masai K, Okubo Y, Kaseda K, Hishida T, Asakura K. Combined Ravitch and Nuss procedure for patients with severe pectus excavatum: technique and initial results. J Surg Case Rep 2023; 2023:rjad576. [PMID: 37942345 PMCID: PMC10629864 DOI: 10.1093/jscr/rjad576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
The Nuss procedure for pectus excavatum (PE) is both less invasive and very simple compared to the Ravitch procedure. However, it may be difficult to perform the Nuss procedure in cases of severe PE. Therefore, we developed a Combined Ravitch and Nuss (CRN) procedure and examined its effectiveness in patients with severe PE. Nine patients with severe PE underwent the CRN procedure. Data on patient characteristics and perioperative results were collected retrospectively. The median Haller index (HI) was 15.4 (range, 6.3-29.3). No significant intraoperative adverse events were noted. Postoperatively, marked improvements in HI were seen in all cases (3.29, range, 2.72-4.96). Two surgical site infections on the shallow layer and one wound seroma occurred. No recurrences were observed during the observation period. Our novel CRN procedure is useful for achieving adequate and sustainable sternal elevation with less invasiveness for patients with severe PE.
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Affiliation(s)
- Kyohei Masai
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582, Japan
| | - Yu Okubo
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582, Japan
| | - Kaoru Kaseda
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582, Japan
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Ermerak NO, Yuksel M. Modification of the Nuss procedure: the crossed bar technique for new subtypes of pectus excavatum. Gen Thorac Cardiovasc Surg 2023; 71:577-583. [PMID: 37179507 DOI: 10.1007/s11748-023-01940-9] [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] [Received: 03/09/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND We aim to describe four new subtypes of PE in detail and represent modification of the Nuss procedure called crossed bar technique for their optimum correction with good results. METHODS 101 patients who underwent crossed bar technique between August 2005 and February 2022 were included into the study. RESULTS The mean age of the patient series was 21.1 (range 15-38 years) years. Mean Haller index was 3.87. Mean operation duration was 86.84 min. 2 bars were used in 74 (73.3%) of the patients whereas 3 bars were preferred in 27 (26.7%) of them. Mean hospital stay was 4.1 (2-8) days, and all the patients were seen routinely on postoperative follow-up at 1st, 6th, and 18th months. Quality of life questionnaires revealed satisfaction. CONCLUSIONS Cross bar technique yields satisfactory results for these new subtypes and can be performed safely with good results in these selected group of patients.
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Affiliation(s)
- Nezih Onur Ermerak
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey.
| | - Mustafa Yuksel
- Department of Thoracic Surgery, Demiroglu Bilim University School of Medicine, Istanbul, Turkey
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Beati F, Frediani S, Pardi V, Aloi I, Bertocchini A, Accinni A, Inserra A. Case report-Every thoracic surgeon's nightmare: cardiac and lung perforation during placement of Nuss bar for pectus excavatum. Front Pediatr 2023; 11:1241273. [PMID: 37744443 PMCID: PMC10513049 DOI: 10.3389/fped.2023.1241273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction The prevalence of life-threatening complications (LTCs) related to the minimally invasive repair of pectus excavatum (MIRPE) is unknown and underreported. The aim of this study is to contribute to the real prevalence of these rare but dramatic complications and show what went wrong in order to prevent it in the future. Case presentation A 15-year-old boy affected by pectus excavatum with severe asymmetric deformity of the chest wall was evaluated for elective corrective surgery. Preoperative computed tomography showed a Haller index of 5.7 and a correction index of 0.40. MIRPE was performed under right video-assisted thoracoscopy. Cardiac arrhythmias occurred after placement of the bar introducer. The introducer was removed, and massive bleeding was noted. Emergency Clamshell thoracotomy was performed, and cardiac surgeon was alerted immediately. A first pulmonary wound was found and controlled. Two cardiac lacerations were found: on the interventricular wall and on the right atrium. Under cardiopulmonary bypass, cardiac lacerations were sutured and other three pulmonary wounds were repaired. An urgent fasciotomy was performed for compartmental syndrome of the right lower art after femoral cannulation. Pulmonary distress occurred; the patient was admitted on ECMO (ExtraCorporeal Membrane Oxygenation) in intensive care unit. Right lower lobectomy was carried out on the fifth postoperative day due to massive pulmonary bleeding requiring temporary tracheostomy. The patient was discharged to rehabilitation after 3 months with no brain injuries, minor hearing loss, and tracheostomy. Conclusion We want to maintain the high alertness required for this procedure. Reporting these scaring complications contributes to the real prevalence of LTCs. We suggest the use of bilateral thoracoscopy and crane elevator in severe sternal defects. We also suggest to have a cardiac surgeon available in the hospital owing to cardiac perforation.
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Affiliation(s)
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Dreher C, Reinsberg M, Oetzmann von Sochaczewski C, Siebert S, Strohm J, Kurz R, Ziegler AM, Heydweiller A, Yavuz ST. Changes in Pulmonary Functions of Adolescents with Pectus Excavatum Throughout the Nuss Procedure. J Pediatr Surg 2023; 58:1674-1678. [PMID: 36935229 DOI: 10.1016/j.jpedsurg.2023.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND We aimed to determine the longitudinal changes in pulmonary functions of adolescents with Pectus Excavatum who underwent the Nuss procedure, the minimally invasive repair of pectus excavatum (MIRPE). METHODS Lung function measurements were performed before bar implantation (T0), at least six weeks to ten months after implantation (T1a), at least eleven months to sixty-one months after bar implantation (T1b) and at least two weeks after bar explantation (T2). RESULTS Data of 114 patients (83.3% male) whose median age at implantation was 15.6 years and at explantation 18.7 years were analyzed. Shortly after implantation at T1a a significant decline of vital capacity (VC; n = 82), forced vital capacity (FVC; n = 78) and forced expiratory volume in 1 second (FEV1; n = 80) compared to T0 was seen. At T1b a significant decline for the residual volume (RV; n = 83), the residual volume/total lung capacity ratio (RV/TLC; n = 81), the total specific airway resistance (sRaw; n = 80) and the total airway resistance (Raw; n = 84) also compared to T0 was measured. In the comparison of T1b to T2 a significant increase of VC, FVC (n = 67), FEV1 (n = 69), TLC (n = 67) and a significant decrease of Raw (n = 66), sRaw, RV (n = 65) and the RV/TLC (n = 64) ratio could be observed. In the direct analysis between T0 and T2, after the explantation of the bar a significant increase in VC (n = 54), FVC (n = 52), and TLC (n = 55) and a significant decrease of RV (n = 51) and the RV/TLC index (n = 50), and in airway resistance parameters like Raw (n = 52) and sRaw (n = 51) could be detected. CONCLUSIONS Lung function values along with markers of airway resistance improve in patients after the complete procedure of MIRPE. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Charlotte Dreher
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany
| | - Max Reinsberg
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany
| | | | - Stephanie Siebert
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany
| | - Joanna Strohm
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Ralf Kurz
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Anna-Maria Ziegler
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Andreas Heydweiller
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Suleyman Tolga Yavuz
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany.
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Lee J, Jeong JY, Suh JH, Park CB, Kim D, Park SS. Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum. Front Surg 2023; 10:1245049. [PMID: 37675251 PMCID: PMC10477697 DOI: 10.3389/fsurg.2023.1245049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Objective Patients with primary spontaneous pneumothorax (PSP) tend to be young, tall, and thin, as do those with pectus excavatum (PE). Notably, the Haller index, which measures the severity of PE, tends also to be higher in patients with PSP, further suggesting a potential predisposing factor for the development of PSP in individuals with PE. This study aimed to share clinical experiences with case series of concomitant PSP and PE and to emphasize the importance of evaluating these two conditions together. Methods In this single-center study, we conducted a retrospective records review to identify patients who were diagnosed and treated (including surgical or conservative treatment and follow-up observation) for the diagnosis of PE between July 2011 and February 2023. From these, we selected patients who were diagnosed with both PE and PSP and analyzed their clinical presentations. Results Among a total of 139 patients with PE, there were 8 (5.76%) who had concurrent diagnoses of PE and PSP and who underwent surgery for PSP, PE, or both. The average age of these 8 patients (male:female = 7:1) was 19.38 years. The 8 patients were grouped into four categories based on their clinical scenarios. Group A had 1 patient with PE diagnosed first, followed by the discovery of PSP during evaluation; Group B included 2 patients initially presenting with PSP and subsequently diagnosed with PE during evaluation; Group C consisted of 1 patient who had PSP before undergoing surgical PE correction; and Group D comprised 4 patients who developed PSP after PE correction. Conclusions The incidence of PSP in patients with PE was 5.76% (8 out of 139 patients), indicating the importance of vigilant monitoring for PSP prior to PE surgery, and vice versa. Furthermore, the authors recommend close observation for PSP independent of PE surgery, even in the absence of postoperative complications.
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Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Beom Park
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dulee Kim
- Department of Anesthesiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Seog Park
- Department of Anesthesiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Wang Q, Pan Z, Wu C, Li Y, Wang G, Dai J, Ren C, Xie Y, Xiong L, Zhang L, Li H. Single Incision non-thoracoscopic Nuss procedure for children with pectus excavatum: protocol for a multicenter, non-masked, randomized controlled trial. Front Surg 2023; 10:1210452. [PMID: 37538392 PMCID: PMC10394465 DOI: 10.3389/fsurg.2023.1210452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023] Open
Abstract
Background Nuss procedure is the most common method of surgical treatment to pectus excavatum (PE). A significant percentage of surgeons choose to use thoracoscopic assistance during the Nuss procedure (TNP) to avoid cardiac injury. However, our previous findings confirm the safety of single incision Non-thoracoscopic Nuss Procedure (SINTNP). Hence, Further studies, particularly prospective randomized controlled trials, are necessary to assess the value of SINTNP for PE. Methods This study is a prospective, superiority, multicenter, non-masked, randomized controlled trial that investigates the outcome and hospitalization medical expense of SINTNP compared to TNP for PE. A total of 320 eligible patients according to sample size calculation by retrospective data will be randomly assigned to the SINTNP group or the TNP group at a 1:1 ratio using stratified blocked randomization and the zone length was set as four. Patients aged between 3 and 18 years old for the first surgery and without combination of complex anomalies such as Marfan syndrome and congenital heart disease will be considered for the study. The co-primary endpoint is thoracic related complications and medical expense during hospitalization. Thoracic related complications were defined as pneumothorax, pleural effusion, pneumonia and incision infection. The secondary endpoints include surgery duration and length of hospital stay.The registration number for this study protocol is ChiCTR230073081 (Chinese Clinical Trial Registry, A Primary Registry of International Clinical Trial Registry Platform, World Health Organization).
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Affiliation(s)
- Quan Wang
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chunnian Ren
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Yiming Xie
- Department of Pediatric Surgery, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Liangjun Xiong
- Department of Pediatric Surgery, Qujing Maternal and Child Health Hospital, Qujing, China
| | - Libing Zhang
- Department of Pediatric Surgery, Chengdu Women and Children’s Central Hospital, Chengdu, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
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Janssen N, Daemen JHT, van Polen EJ, Coorens NA, Jansen YJL, Franssen AJPM, Hulsewé KWE, Vissers YLJ, Haecker FM, Milanez de Campos JR, de Loos ER. Pectus Excavatum: Consensus and Controversies in Clinical Practice. Ann Thorac Surg 2023; 116:191-199. [PMID: 36997016 DOI: 10.1016/j.athoracsur.2023.02.059] [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: 10/26/2022] [Revised: 02/08/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are being used. Their use is predominantly based on local preferences and experience. To date, no guideline is available, introducing heterogeneity of care as observed in current daily practice. The aim of this study was to evaluate consensus and controversies regarding the diagnostic protocol, indications for surgical correction, and postoperative evaluation of pectus excavatum. METHODS The study consisted of 3 consecutive survey rounds evaluating agreement on different statements regarding pectus excavatum care. Consensus was achieved if at least 70% of participants provided a concurring opinion. RESULTS All 3 rounds were completed by 57 participants (18% response rate). Consensus was achieved on 18 of 62 statements (29%). Regarding the diagnostic protocol, participants agreed to routinely include conventional photography. In the presence of cardiac impairment, electrocardiography and echocardiography were indicated. Upon suspicion of pulmonary impairment, spirometry was recommended. In addition, consensus was reached on the indications for corrective surgery, including symptomatic pectus excavatum and progression. Participants moreover agreed that a plain chest radiograph must be acquired directly after surgery, whereas conventional photography and physical examination should both be part of routine postoperative follow-up. CONCLUSIONS Through a multiround survey, international consensus was formed on multiple topics to aid standardization of pectus excavatum care.
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Affiliation(s)
- Nicky Janssen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Jean H T Daemen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Elise J van Polen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Nadine A Coorens
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Yanina J L Jansen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Aimée J P M Franssen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Frank-Martin Haecker
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Jose R Milanez de Campos
- Department of Thoracic Surgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil; Department of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands.
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Bhatnagar V, Kumar R, Singh A, Singh M, Darlong LM, Mittal AK. Comparative Study Between Intravenous Patient-Controlled Analgesia Morphine and Computerized Ambulatory Delivery Device Epidural Morphine for Post Operative Analgesia for Nuss Procedure in Pectus Excavatum: A Retrospective Analysis. Cureus 2023; 15:e41301. [PMID: 37539397 PMCID: PMC10394658 DOI: 10.7759/cureus.41301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Pectus deformities are commonly seen in chest wall deformities among the pediatric age group. Pectus deformities occur due to defective growth of the sternum and its surrounding cartilage. The Nuss procedure is the technique of choice for correcting the deformity surgically which includes placing a convex bar under the sternum without resection or injury to costal cartilages. Adequate pain control is utmost to improve wound healing, patient satisfaction, short hospital stays, and decrease the financial burden on attendants. Therefore, it is necessary to investigate which analgesic method is more advantageous for the Nuss procedure. OBJECTIVE To compare the analgesic effects of intravenous patient-controlled analgesia (IVPCA) morphine versus computerized ambulatory delivery device (CADD) epidural morphine on acute post-operative pain management in Nuss procedures. METHODS A retrospective study was done at Rajiv Gandhi Cancer and Research Hospital, New Delhi from 2015 to 2020 to assess the efficacy and safety between IVPCA morphine and CADD epidural for post-operative analgesia following pectus excavatum repair. A total of 34 cases of Nuss procedures were taken with 17 cases in each group. Group 1 (intravenous PCA morphine) was given 39 ml normal saline + 6 ml morphine (total 45 ml, 2 mg/ml morphine), set at demand dose 0.5 ml, i.e. 1 mg, lockout interval 7 minutes, doses per hour was six and Group 2 (CADD epidural morphine) was given 42 ml normal saline + 3 ml morphine (1 mg/ml morphine) with continuous infusion at the rate of 0.5 ml/hr. Demand dose 0, lockout interval nil. Visual analog pain scores using a scale of 0-10 and Ramsay Sedation Score (RSS) scores were obtained on arrival at the post-anesthesia care unit, at 12, 24, 48, and 72 hours throughout the subsequent hospital stay. RESULTS This study yielded positive information about our experience with the pectus post-operative pain management. The mean visual analog scale (VAS) score was lower in Group 1 compared to Group 2 but significantly different at 12 and 72 hours only. The mean RSS score was comparable between groups. The mean hospital stay (days) and requirement of rescue analgesia doses were 3.47±0.51 and 0.12±0.33 in Group 1 and 4.76±0.44, 0.59±1.12 in Group 2. CONCLUSION Both IVPCA morphine and CADD morphine were effective in controlling post-surgical pain in the Nuss procedure, but IVPCA morphine was better as compared to CADD morphine in this regard because it was noninvasive, safe, and cost-effective with non-significant complications.
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Affiliation(s)
- Vishal Bhatnagar
- Surgical Intensive Care Unit, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, IND
| | - Ravi Kumar
- Plastic Surgery, King George's Medical University, Lucknow, IND
| | - Anshu Singh
- Plastic Surgery, King George's Medical University, Lucknow, IND
| | - Manish Singh
- Plastic Surgery, Lala Lajpat Rai Memorial Medical College, Meerut, Meerut, IND
| | - L M Darlong
- Thoracic Onco-Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, IND
| | - Amit Kumar Mittal
- Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, IND
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Arredondo Montero J, Hernández-Martín S, Martín-Calvo N, Bardají Pascual C. Development and clinical application of a new sternal zenithal traction system in video-assisted percutaneous thoracoplasty. Cir Esp 2023; 101:319-324. [PMID: 36067947 DOI: 10.1016/j.cireng.2022.09.009] [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] [Received: 10/17/2021] [Accepted: 01/26/2022] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Video-assisted percutaneous thoracoplasty involves a complex surgical access with risk of damaging vital structures during the procedure. Historically, different traction and sternal elevation systems have been applied during the intervention to minimize the risk associated with the passage of the instruments between the sternum and the pericardium. MATERIAL AND METHODS A new sternal traction system is presented by means of an illustrated description. Clinical and sociodemographic data were extracted from the 36 patients operated in our center for Pectus Excavatum between July 2017 and August 2021. The Haller index was not applied as a criterion to determine the use or not of the sternal traction system. Patients were classified according to whether the sternal traction system (TE) or not (ST) had been employed. Statistical analysis of the data collected was performed with STATA, version 15.0 (StataCorp). RESULTS Both groups were comparable. Haller's Index was 4.19 ± 0.7 for the sternal traction (TE) group and 3.79 ± 0.3 for the no sternal traction (ST) group. In 25 of the patients the described traction system was used, and in 11 no traction system was used. All patients were operated on by the same surgeon. The mean operative time in minutes was 97.73 ± 46.2 for the ST group and 88.13 ± 18.1 for the TE group (p = 0.87). The mean total days of admission was 7.67 ± 0.82 (TE) and 7.73 ± 1.35 (ST). Mean days of intravenous PCA was 6.08 ± 0.72 (TE) and 5.89 ± 1.45 (ST). The mean number of epidural PCA days was 3.79 ± 0.5 (TE) and 3.36 ± 0.5 (ST) (p = 0.01). All patients presented a favorable postoperative evolution. None of the patients presented discomfort at the level of the sternal wounds during hospitalization. Cosmetic evolution was favorable in all patients. CONCLUSIONS The sternal traction system presented provides safety when performing retrosternal dissection and placement of the thoracoplasty bar, leading to a decrease in surgical time in cases with a Haller Index higher than 3.5. There have been no complications associated with its use, nor has there been an increase in the number of days of hospitalization or analgesic requirements. There are no aesthetic sequelae for the patients.
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Affiliation(s)
- Javier Arredondo Montero
- Servicio de Cirugía Pediátrica, Hospital Universitario de Navarra, Pamplona, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | | | - Nerea Martín-Calvo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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What Is the Appropriate Timing for Bar Removal After the Nuss Repair for Pectus Excavatum? J Surg Res 2023; 285:136-141. [PMID: 36669392 DOI: 10.1016/j.jss.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 12/07/2022] [Accepted: 12/24/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The Nuss procedure for pectus excavatum requires that the sternal elevation be maintained by indwelling metal bars that are traditionally removed approximately 3 y after the repair. METHODS A retrospective cohort study was conducted of all patients who underwent primary Nuss repair from 2007 to 2018 in two institutions and had a follow-up of at least 24 mo. Pectus bars had been left in place beyond 3 y in patients concerned over possible recurrence after bar removal. Structured interviews were held to assess pain, chest tightness, or other discomfort, and any adverse events related to pectus bars. Results were compared between patients in whom pectus bars were removed after 3 y (standard group) and those in whom bars were left in place longer (extended bar duration group). RESULTS Two hundred and thirty-one patients (91% males, mean age 23.9 ± 8.3, mean Haller index 4.9 ± 2.3) were included. Bar duration was 30.6 ± 6.6 mo in the standard group (51 patients) versus 69.1 ± 26.3 mo in the extended group (180 patients). Some discomfort was reported by 81.6% in the standard group versus 62.9% in the extended group (P = 0.033), and discomfort occurring at least monthly or more often was only reported by 30% in the standard versus 30.3% in the extended group (P = 1.000). Quality of life improved in 92.6% of the standard group versus 94.7% of the extended group (P = 1.000). No significant adverse events were reported in either group. CONCLUSIONS Our data suggest that an extended bar duration after the Nuss repair may not cause any adverse event nor negatively affect quality of life.
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Cujiño-Álvarez IF, Torres-Salazar D, Velásquez-Galvis M. Cardiorespiratory arrest during and after nuss procedure: case report. J Cardiothorac Surg 2023; 18:166. [PMID: 37118746 PMCID: PMC10148508 DOI: 10.1186/s13019-023-02262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/03/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Pectum excavatum is a congenital thoracic alteration that can present important physiological alterations depending on the severity of the case. The Nuss procedure is a minimally invasive technique for managing chest wall deformity, in which there is a risk of perioperative complications. CASE PRESENTATION This article presents the case of a 16-year-old patient who underwent placement of a Nuss bar and suffered intraoperative and postoperative cardiorespiratory arrest. CONCLUSIONS it is important to consider the possible early and late complications scenarios as well as their treatment in patients with pectum excavatum scheduled for a Nuss procedure.
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Affiliation(s)
- Indira F Cujiño-Álvarez
- Anesthesiology Department, Anesthestiologist. Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia.
| | - Daniela Torres-Salazar
- Anesthesiology Resident. Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18 No. 122- 135, Cali, Colombia
| | - Mauricio Velásquez-Galvis
- Thoracic Surgery Department, Thoracic Surgeon. Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia
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