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Weinhandl AC, Ermerak NO, Yüksel M, Rebhandl W. 'Short Bars Crossed' to Remodel the Entire Chest Wall in Children and Adolescents with Pectus Excavatum. J Pediatr Surg 2024:S0022-3468(24)00350-6. [PMID: 38914508 DOI: 10.1016/j.jpedsurg.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The cross-bar technique of minimally invasive pectus excavatum (PE) correction remains underreported, which is especially true of pediatric patients. We therefore reviewed the experience of a Turkish and an Austrian center. An additional novelty characterizing both pediatric cohorts was the use of short bars. METHODS In a retrospective study, pediatric PE corrections involving 'short bars crossed' were analyzed for complications and intra-/postoperative outcomes. Cases with two or three bars were included, given that a horizontal third bar was placed whenever considered useful for upper-chest elevation. All bars were fitted with a single stabilizer near the surgical entry point. In the Austrian center, intercostal nerve cryoablation was used for pain management. Descriptive statistics are presented. RESULTS Seventy-eight patients ≤18 years old were evaluable at the Turkish (n = 56) and Austrian (n = 22) centers. Total median values were 16.2 (IQR: 15.1-17.4) years for age and 4.60 (IQR: 3.50-6.11) for Haller index. Ten mild or moderate complications (12.8%) were observed, including just one revision requirement due to bar migration (1.28%). Intercostal nerve cryoablation (n = 13) was associated with longer surgical procedures at 150 (IQR: 137-171) versus 80 (IQR: 60-100) minutes but with shorter hospital stays, given an IQR of 3-4 days versus 4-5 days. CONCLUSION 'Short bars crossed'-with a single stabilizer in a ventral position close to the surgical entry point-ensure a wide distribution of forces, protect against bar migration, are safe and effective, and offer stability at an age characterized by growth and physical activity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anja C Weinhandl
- University Clinic of Pediatric and Adolescent Surgery, Comprehensive Center for Pediatrics, Medical University of Vienna, Austria
| | - Nezih O Ermerak
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Yüksel
- Department of Thoracic Surgery, Emeritus Prof of Marmara University Lecturer of TC, Demiroglu Bilim University Medical School, Istanbul, Turkey
| | - Winfried Rebhandl
- University Clinic of Pediatric and Adolescent Surgery, Comprehensive Center for Pediatrics, Medical University of Vienna, Austria.
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2
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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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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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Briscoe WE, Miles MVP, Byers B, Rippy M, Smith L. Management of Internal Mammary Artery Injuries Associated With the Nuss Procedure. Am Surg 2023:31348231161696. [PMID: 36881966 DOI: 10.1177/00031348231161696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The minimally invasive repair of pectus excavatum (MIRPE), or Nuss procedure, is regarded as the gold standard technique for the treatment of symptomatic pectus excavatum. Minimally invasive repair of pectus excavatum is regarded as a low-risk operation with a reported life-threatening complication rate estimated at around 0.1%. Presented are three cases of right internal mammary artery injury (RIMA) after MIRPE resulting in massive hemorrhage in both the acute and chronic postoperative setting and subsequent management strategies. Exploratory thoracoscopy and angioembolization were utilized which achieved prompt hemostasis and allowed for complete patient recovery.
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Affiliation(s)
- William Eric Briscoe
- Department of Surgery, 70274University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - M Victoria Purvis Miles
- Department of Surgery, 70274University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Brynn Byers
- Department of Surgery, 70274University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Meredith Rippy
- 14733University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Lisa Smith
- Department of Surgery, 70274University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
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5
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Stephens EH, Dearani JA, Jaroszewski DE. Pectus Excavatum in Cardiac Surgery Patients. Ann Thorac Surg 2023; 115:1312-1321. [PMID: 36781097 DOI: 10.1016/j.athoracsur.2023.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Pectus excavatum frequently accompanies congenital heart disease and connective tissue diseases requiring cardiac surgery. Sometimes the indication is cardiac repair, with the pectus being incidentally noticed; other times, the pectus subsequently develops or becomes more significant after cardiac surgery. This review arms cardiac and congenital surgeons with background about the physiologic impact of pectus, indications for repair and repair strategies, and outcomes for cardiac surgery patients requiring pectus repair. METHODS A comprehensive literature review was performed using keywords related to pectus excavatum, pectus repair, and cardiac/congenital heart surgery within the PubMed database. RESULTS The risks of complications related to pectus repair, including in the setting of cardiac surgery or after cardiac surgery, are low in experienced hands, and patients demonstrate cardiopulmonary benefits and symptom relief. Concomitant pectus and cardiac surgery should be considered if it is performed in conjunction with those experienced in pectus repair, particularly given the increased cardiopulmonary impact of pectus after bypass. In the setting of potential bleeding or hemodynamic instability, delayed sternal closure is recommended. For those with anticipated pectus repair after cardiac surgery, the pericardium should be reconstructed for cardiac protection. For those undergoing pectus repair after cardiac surgery without a membrane placed, a "hybrid" approach is safe and effective. CONCLUSIONS Patients undergoing cardiac surgery noted to have pectus should be considered for possible concomitant or staged pectus repair. For those who will undergo a staged procedure, a barrier membrane should be placed before chest closure.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dawn E Jaroszewski
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
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6
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Complications following metal bar removal after Nuss repair are rare in a duocentric retrospective evaluation. Pediatr Surg Int 2022; 38:1919-1924. [PMID: 36138322 PMCID: PMC9653328 DOI: 10.1007/s00383-022-05250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Minimally invasive pectus excavatum repair has gained widespread acceptance and its results and complications are well-described. However, there is a substantial debate on the risks and frequencies of complications following metal bar removal. We, therefore, aimed to analyse all complications that occurred during and after metal bar removal at our two paediatric surgical centres. METHODS Bar removal surgeries were identified via procedural codes and electronic records were reviewed using a pre-specified data extraction chart. Both intra- and postoperative complications were included and the latter scored according to Clavien-Dindo. We analysed the influence of the pre-specified potential predictors age, sex, and the number of implanted metal bars on the occurrence of complications using logistic regression. RESULTS We included 279 patients with a median age of 19 years (interquartile range 17-20 years). 15 patients experienced 17 complications. Of 11 postoperative complications, only an enlarging pleural effusion required a chest drain in local anaesthesia, resulting in a Claven-Dindo grade IIIa, whereas the remainder were classified as grade I. Neither age (adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.84-1.13, P = 0.73), nor sex (aOR 0.88, 95% CI 0.19-4.07, P = 0.87) or the number of bars (aOR 0.64, 95% CI 0.15-2.71, P = 0.547) did influence the occurrence of complications. CONCLUSION Complications following metal bar removal were scarce in our duocentric retrospective series and usually of minor relevance. However, to address the perceived paucity of data on the frequency and severity of complications following metal bar removal, further studies, including large database research is necessary.
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Anbarasu CR, Mehl SC, Sun RC, Portuondo JI, Espinoza AF, Whitlock RS, Shah SR, Rodriguez JR, Nuchtern JG, Minifee PK, Le LD, Stafford SJ, Milewicz AL, Mazziotti MV. Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review. Eur J Pediatr Surg 2022; 32:357-362. [PMID: 34560787 DOI: 10.1055/s-0041-1735164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. MATERIALS AND METHODS We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. RESULTS Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. CONCLUSION Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.
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Affiliation(s)
- Centura R Anbarasu
- Department of Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Steven C Mehl
- Department of Surgery, Baylor College of Medicine, Houston, Texas, United States.,Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Raphael C Sun
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Jorge I Portuondo
- Department of Surgery, Baylor College of Medicine, Houston, Texas, United States.,Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Andres F Espinoza
- Department of Surgery, Baylor College of Medicine, Houston, Texas, United States.,Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Richard S Whitlock
- Department of Surgery, Baylor College of Medicine, Houston, Texas, United States.,Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Sohail R Shah
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - J Ruben Rodriguez
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Paul K Minifee
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Louis D Le
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Shawn J Stafford
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Allen L Milewicz
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Mark V Mazziotti
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, United States
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8
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Liu S, Wang L, Zhang H, Zeng W, Hu F, Xiao H, Li G, Mei J, Zhu J. Modified Nuss procedure with a novel steel bar in patients with pectus excavatum post-congenital heart surgery. Interact Cardiovasc Thorac Surg 2021; 34:424-430. [PMID: 34661678 PMCID: PMC8860435 DOI: 10.1093/icvts/ivab284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/29/2021] [Accepted: 09/20/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Pectus excavatum (PE) can be secondary in patients who underwent sternotomy for cardiac surgery. Retrosternal adhesions increase the complexity and risk of traditional Nuss repair. Thus, we summarized the outcomes of our modified Nuss procedure using a newly designed bar. METHODS A retrospective analysis was performed on 35 patients who underwent modified PE repair after open heart surgery from January 2011 to July 2019. The surgery was performed using a novel bar with no need for intraoperative reshaping and rotation, assisted by thoracoscopy and subxiphoid incision when necessary. RESULTS There were 19 males and 16 females with a median age of 5.3 years (interquartile range, 4.1–10.9) at PE repair. All patients underwent the modified procedure uneventfully with no death. The median operating time was 70 min. Twenty-nine (82.9%) patients required subxiphoid incision assistance. There was 1 case (2.8%) with unexpected sternotomy due to intraoperative bleeding. The median length of postoperative hospital stay was 4 days. During the median 3.5 years of follow-up, no bar dislocation was found and 30 (85.7%) patients had their bars removed with no recurrence recorded. After PE repair, the Haller index improved significantly (2.6 ± 0.4 vs 4.9 ± 1.3, P < 0.05) and further decreased till the time of bar removal (2.5 ± 0.4 vs 2.6 ± 0.4, P < 0.05). All patients were satisfied with the cosmetic outcome. CONCLUSIONS The novel bar can be placed and removed easily with a low rate of adverse events. This modified Nuss procedure seems to be a safe, effective and convenient approach for the management of PE after cardiac surgery.
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Affiliation(s)
- Siming Liu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Wang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongkun Zhang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenhui Zeng
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fengqing Hu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Xiao
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guoqing Li
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiaquan Zhu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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9
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Complications and trends in minimally invasive repair of pectus excavatum: A large volume, single institution experience. J Pediatr Surg 2021; 56:1846-1851. [PMID: 33279219 DOI: 10.1016/j.jpedsurg.2020.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Complication risk in minimally invasive repair of pectus excavatum (MIRPE) is not negligible, particularly during learning curve. We reviewed the complications of a large series, evaluated the correlation with technical details and learning curve, and presented the strategies implemented to reduce them. METHODS Data on MIRPE patients from 2005 to 2020 (divided in two groups: before and after 2013) were collected prospectively and reviewed. Complications were correlated to the number and type of bar/stabilizers, and to the surgeon learning curve. RESULTS We placed 783 bars (484 Biomet, 273 Intrauma and 26 others) in 600 patients and removed 524 bars in 436 patients. Complications occurred in 108 MIRPE (18%): 3.7% intraoperative, 14.3% postoperative. No cardiac perforations were reported; in the second period we had fewer complications (15.3% versus 28.2%) particularly in intraoperative ones (0.3% versus 9%), the intervention was faster (64 versus 83 min and 92 versus 127 for 1 and 2 bars) and hospitalization shorter (5 versus 7.5 days). Complication rate of bar removal was 2.7% (all Biomet bars): one intra-thoracic bleeding and 2 lung injuries. CONCLUSIONS MIRPE has a significant rate of complication, especially during learning curve. Postoperative complications are more frequent and less dependent on learning curve. Severe complications can be observed during bar removal. We have adopted new bars to reduce complications, but dislocation remains an unresolved problem.
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Fan YJ, Lo PC, Hsu YY, Tzeng IS, Wei BC, Cheng YL. A retrospective study on the impact of bar flipping on the recurrence of pectus excavatum after the Nuss procedure. J Cardiothorac Surg 2021; 16:244. [PMID: 34454561 PMCID: PMC8400763 DOI: 10.1186/s13019-021-01621-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background The Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping. Methods This retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI × 100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests. Results In this study, 359 adult and adolescent patients with an average age of 23.9 ± 7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n = 131), α = 11–20° (n = 154), α = 21–30° (n = 51), and α > 30° (n = 23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p < 0.001). Conclusions The α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.
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Affiliation(s)
- Yu-Jiun Fan
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, No. 289, Jianguo Road, Xindian District, 231, Taiwan
| | - Po-Cheng Lo
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, No. 289, Jianguo Road, Xindian District, 231, Taiwan
| | - Yuan-Yu Hsu
- Department of Radiology, 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
| | - Bo-Chun Wei
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, No. 289, Jianguo Road, Xindian District, 231, Taiwan
| | - Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, No. 289, Jianguo Road, Xindian District, 231, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Abstract
Over the past few decades, there have been many advances in pediatric surgery, some using new devices (eg, VEPTR, MAGEC rods) and others using less invasive approaches (eg, Nuss procedure, endoscopic cranial suture release, minimally invasive tethered cord release). Although many of these procedures were initially met with caution or skepticism, continued experience over the past few decades has shown that these procedures are safe and effective. This article reviews the anesthetic considerations for these conditions and procedures.
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Affiliation(s)
- Johanna Meehyun Lee
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB 444, Boston, MA 02114, USA
| | - Erica Gee
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB 444, Boston, MA 02114, USA
| | - Chang Amber Liu
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB 444, Boston, MA 02114, USA.
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12
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Nguyen TM, Le VT, Nguyen HU, Pham HL, Phung HSD, Vu NT, Nguyen VA, Do NK, Vu KD, Vo HL, Doan QH. An Initial 5-Year Single-Center Experience of 365 Patients Undergoing the Video-Assisted Thoracoscopic Surgery for Nuss Procedure for Pectus Excavatum in Resource-Scare Setting. Front Surg 2021; 8:693562. [PMID: 34195225 PMCID: PMC8236539 DOI: 10.3389/fsurg.2021.693562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Little is known about video-assisted thoracoscopic surgery in the Nuss procedure (VATS-NUSS) and its postoperative outcomes in the resource-scarce conditions in clinical practice such as Vietnam. Available evidence in the literature was mostly reported from large institutions in developed countries. Hence, this study was conducted to review our initial large single-center experience in the use of the VATS-NUSS for patients with pectus excavatum (PE) within 5 years. Methods: Data from 365 consecutive PE patients between January 2015 and December 2019 who were surgically treated with VATS-NUSS were retrospectively analyzed. Results: Of 365 patients, median age at operation was 15.61 ± 3.73 years (range = 5–27 years), most being child and adolescent. Three hundred nine patients (84.65%) were male. PE was commonly detected at puberty (n = 328, 89.9%). Postoperatively, early complications consisted of pneumothorax (n = 5, 1.37%), pleural bleeding/pleural fluid (n = 2, 0.55%), pleural hematoma (n = 1, 0.27%), pneumonia (n = 1, 0.27%), surgical wound infection (n = 1, 0.27%), incision fluid accumulation (n = 3, 0.82%), metal bar infection (n = 1, 0.27%), atelectasis (n = 3, 0.82%), and fever (n = 8, 2.19%). Late complications included surgical wound infection (n = 2, 0.55%), metal bar deviation (n = 5, 1.37%), metal bar allergy (n = 10, 2.74%), recurrent PE (n = 2, 0.55%), and persistent PE (n = 5, 1.37%). No deaths occurred. In 175 patients (47.95%) experiencing bar removal, mean operative time for bar removal was 34.09 ± 10.61 min, and the length of hospitalization following bar removal was 2.4 ± 1.34 days; the most frequent complication was pneumothorax (n = 19, 10.85%). One wound infection and one incision fluid accumulation happened following bar removal. Favorable midterm to long-term postoperative outcomes were achieved. Conclusions: From the beginning of the Vietnamese surgeons' experience, VATS-NUSS application obtained favorable outcomes with minimizing the occurrence of serious intraoperative and postoperative complications. Current rare evidence enables to give a real picture in the application, modification, and development of VATS-NUSS in the countries having similar resource-scarce conditions.
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Affiliation(s)
- The-May Nguyen
- Department of Cardiovascular and Thoracic Surgery, Viet-Tiep Friendship Hospital, Hai Phong, Vietnam
| | - Van-Thieu Le
- Department of Cardiovascular and Thoracic Surgery, Viet-Tiep Friendship Hospital, Hai Phong, Vietnam
| | - Huu-Uoc Nguyen
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam.,Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Huu-Lu Pham
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Hong-Son Duy Phung
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Ngoc-Tu Vu
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam.,Department of Cardiovascular and Thoracic Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Viet-Anh Nguyen
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Nam-Khanh Do
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kim-Duy Vu
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hoang-Long Vo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Quoc-Hung Doan
- Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam.,Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
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Analyzing Outcomes of Nuss and Ravitch Repair for Primary and Recurrent Pectus Excavatum in Adults. Ann Thorac Surg 2020; 110:272-275. [DOI: 10.1016/j.athoracsur.2019.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/21/2019] [Accepted: 12/04/2019] [Indexed: 11/21/2022]
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Kovács T, Pásztor G, Rieth A. Internal Mammary Artery Compression After Pectus Excavatum Repair Does Not Increase Risk of Hemorrhagic Complications in Pediatric Patients. Front Pediatr 2020; 8:619065. [PMID: 33469524 PMCID: PMC7813807 DOI: 10.3389/fped.2020.619065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives: Minimal invasive repair of pectus excavatum (MIRPE) described by Nuss is the most popular correction nowadays of this deformity. During the introduction of the bars, they can hurt or compress the internal mammary arteries (IMA). The aim of this study was to observe the prevalence of IMA compression in children after MIRPE. Also, we examined if IMA obstruction increases the risk of complications at bar removal, and if these vascular changes are reversible. Materials and Methods: All patients operated on pectus excavatum in our tertiary pediatric surgical center between 2013 and 2019 were involved in the study. Data of age, sex, number of bars and characteristics of the deformity were examined. IMA flow was checked by Doppler ultrasound (DUS) after MIRPE and after bar removal, too. Results: Among 41 patients with mean age of 15.2 years there were 18 asymmetrical deformities, 23 sternal rotations. Mean pectus index was 4.01. After the Nuss procedure 7(9%) stenoses and 10(12%) occlusions of IMA were found on DUS. After bar removal 3 of 4 stenoses have resolved, but all examined occlusions (3/3) persisted. There were no complications during bar removals. Conclusion: IMA compression after MIRPE in children is uncommon, and is not influenced by severity of deformity. Obstruction of these vessels does not increase the risk of hemorrhagic complications at bar removal. Data of larger cohort are needed to determine reversibility of these changes.
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Affiliation(s)
- Tamás Kovács
- Unit of Pediatric Surgery, Department of Pediatrics, Albert Szent-Gyorgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gyula Pásztor
- Department of Radiology, Albert Szent-Gyorgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anna Rieth
- Unit of Pediatric Surgery, Department of Pediatrics, Albert Szent-Gyorgyi Clinical Center, University of Szeged, Szeged, Hungary
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