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Huh J, Koo JM, Kim M, Choi H, Park HJ, Rim GM, Hwang W. Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study. J Clin Med 2024; 13:3593. [PMID: 38930122 PMCID: PMC11204463 DOI: 10.3390/jcm13123593] [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: 05/20/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A prospective randomized controlled study was conducted on children aged 3-6 years scheduled for elective MIRPE. Patients were randomized into either a routine overnight fasting group (NPO) or a clear liquid group. The incidence and severity of emergence delirium (ED) were assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales at recovery room. Postoperative pain scores and opioid requirements were evaluated at intervals of 1-6 h, 6-12 h, and 12-24 h after surgery. Results: Fasting time was 178.6 ± 149.5 min and 608.9 ± 148.4 min in the clear liquid group compared and NPO group, respectively. The incidence of ED, measured by PAED and Watcha scales, was lower in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%, p = 0.037; Watcha score ≥ 3: 51.9% vs. 85.2%, p = 0.019). The highest PAED score recorded in the recovery room was significantly lower in the clear liquid group (11.4 ± 2.8 vs. 14.6 ± 2.8, p < 0.001). Clear liquid group showed significantly lower pain scores at 1-6, 6-12, and 12-24 h postoperatively. Additionally, clear liquid group had lower opioid requirement at 1-6 and 6-12 h postoperatively. Conclusions: Preoperative clear liquid consumption was associated with a lower incidence of ED in pediatric patients undergoing MIRPE.
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Affiliation(s)
- Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Jung-Min Koo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Minju Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
| | - Hyung-Joo Park
- Department of Thoracic and Cardiovascular Surgery, Nanoori Hospitals, Seoul 06048, Republic of Korea;
| | - Gong-Min Rim
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea;
| | - Wonjung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.H.); (J.-M.K.); (M.K.); (H.C.)
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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: 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: 12/11/2023] [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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Carter M, Prendergast F, Krauss J, Zeineddin S, Pitt JB, Sullivan GA, Abdullah F, Gulack BC, Goldstein SD. Evaluating Skeletal Maturity at Time of Surgical Correction of Pectus Excavatum Based on Medial Clavicle Epiphyseal Ossification. Am Surg 2024; 90:631-639. [PMID: 37824167 DOI: 10.1177/00031348231207296] [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] [Indexed: 10/13/2023]
Abstract
BACKGROUND Surgical correction of pectus excavatum (SCOPE) is dependent upon chest wall pliability with optimal timing prior to complete skeletal maturation. Measures of skeletal maturity are not readily available for operative planning; therefore, surgeons use age as proxy despite patient-specific rates of skeletal maturation. We aimed to determine whether preoperative skeletal maturity is associated with postoperative pain as surrogate for chest wall pliability. METHODS Children ≤18 years who underwent SCOPE from 2020 to 2022 were retrospectively identified. Preoperative CT within 3 months of procedure was reviewed by 2 radiologists and 1 surgeon. Skeletal maturity was determined by Schmeling-Kellinghaus classification which stages secondary epiphyseal ossification of the medial clavicle. Inter-rater reliability was evaluated. Schmeling-Kellinghaus stage and postoperative pain were compared. RESULTS Of twenty-eight records reviewed, 57% were Schmeling-Kellinghaus stage 1. High inter-rater reliability was identified (inter-radiologist: kappa = .95, P < .001, all raters: kappa = .78, P < .001). Median age at operation was 15.5 years (interquartile range: 14.8-16.0) and increased with skeletal maturity (P < .001). When comparing stage 1 (n = 16) to >1 (n = 12), stage 1 had lower maximum pain scores (P < .001), total morphine equivalents (P < .001), and benzodiazepine use (P < .001) after surgery. CONCLUSIONS The Schmeling-Kellinghaus classification system is a valid proxy of skeletal maturity that can be applied with high inter-rater reliability. SCOPE during stage 1 was found to have less postoperative pain and narcotic use than more mature stages. This is proof of concept that skeletal maturity should be considered when determining optimal timing of surgical correction. Future research will evaluate the impact of skeletal maturity on postoperative outcomes.
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Affiliation(s)
- Michela Carter
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francis Prendergast
- Department of Radiology, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jillian Krauss
- Department of Radiology, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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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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Media AS, Christensen TD, Katballe N, Juhl-Olsen P, Vad H, Petersen RH, Højsgaard A, Vincenzo de Paoli F. Complication rates rise with age and Haller index in minimally invasive correction of pectus excavatum: A high-volume, single-center retrospective cohort study. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00107-7. [PMID: 38340954 DOI: 10.1016/j.jtcvs.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The study objectives were to describe the compounded complication rate of minimally invasive repair of pectus excavatum, identify predisposing risk factors, and evaluate the optimal timing of correction. Minimally invasive repair of pectus excavatum is the standard treatment for pectus excavatum and consists of 2 invasive procedures, for example, correction with bar insertion followed by bar removal after 2 to 3 years. METHODS A retrospective cohort study identifying children, adolescents, and adults of both genders corrected for pectus excavatum with minimally invasive repair of pectus excavatum between 2001 and 2022. Information on complications related to bar insertion and removal procedures for each individual patient was compiled into a compounded complication rate. Complication severities were categorized according to the Clavien-Dindo classification. RESULTS A total of 2013 patients were corrected by minimally invasive repair of pectus excavatum with a median age (interquartile range) for correction of 16.6 (5) years. Overall compounded complication rate occurred at a frequency of 16.4%, of which 9.3% required invasive reinterventions (Clavien-Dindo classification ≥IIIa). The complication rate related to bar insertion was 2.6-fold higher compared with bar removal (11.8% vs 4.5%, respectively). Multivariable analysis revealed age (adjusted odds ratio, 1.05; P < .001), precorrection Haller Index (adjusted odds ratio, 1.10; P < .033), and early-phase institutional experience (adjusted odds ratio, 1.59; P < .002) as independent predisposing risk factors. The optimal age of correction was 12 years, and the compounded complication rate correlated exponentially with age with a doubling time of 7.2 years. Complications increased 2.2-fold when the Haller index increased to 5 or more units. CONCLUSIONS Minimally invasive repair of pectus excavatum is associated with a high compounded complication rate that increases exponentially with age and high Haller Index. Consequently, we recommend repair during late childhood and early adolescence, and emphasize the importance of informing patients and relatives about the significant risks of adult correction as well as the need of 2 consecutive procedures taking the complication profile into account before planning surgery.
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Affiliation(s)
- Ara S Media
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Katballe
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Juhl-Olsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Vad
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Anette Højsgaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Frank Vincenzo de Paoli
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark.
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Koo JM, Park HJ, Rim GM, Hyun K, Huh J, Choi H, Kim Y, Hwang W. Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management. J Clin Med 2023; 12:5240. [PMID: 37629283 PMCID: PMC10455545 DOI: 10.3390/jcm12165240] [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: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Children with pectus excavatum are treated with surgical repair in a procedure known as minimally invasive repair of pectus excavatum (MIRPE). MIRPE causes considerable postoperative pain, resulting in the administration of a substantial dose of opioids. This study aimed to identify perioperative factors that influence the requirement for opioids in children undergoing MIRPE. Retrospective data from children who underwent MIRPE were analyzed. A multimodal analgesic protocol was implemented with a continuous wound infiltration system and administration of non-opioid analgesics. Intravenous opioid analgesics were administered if the pain score was greater than 4. The cumulative opioid use was assessed by calculating the morphine equivalent dose at 6, 24, and 48 h after surgery. Perioperative factors affecting the postoperative opioid use were identified with multiple linear regression analyses. This study included 527 children aged 3-6 years, with a mean age of 3.9 years. Symmetrically depressed chest walls, a lower Haller index, and a lower revised depression index were found to be associated with decreased postoperative opioids. Boys required higher opioid doses than girls. Longer pectus bars (10 inches versus 9 inches) were associated with increased opioid use. Severity indices, gender, and the length of pectus bars influence postoperative opioid requirement in children undergoing MIRPE surgery with multimodal analgesia.
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Affiliation(s)
- Jung Min Koo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
| | - Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Nanoori Hospitals, Seoul 06048, Republic of Korea; (H.J.P.); (G.M.R.)
| | - Gong Min Rim
- Department of Thoracic and Cardiovascular Surgery, Nanoori Hospitals, Seoul 06048, Republic of Korea; (H.J.P.); (G.M.R.)
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea;
| | - Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
| | - Yunji Kim
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si 11765, Republic of Korea;
| | - Wonjung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
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Vy TT, Phuoc NL, Thuy TTM, Dinh LQ, Phuong DD, Cuong LT, Bang HT. Surgical treatment of a sternal cleft associated with pectus excavatum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Current Development of Minimally Invasive Repair of Pectus Excavatum (MIRPE). CHILDREN 2022; 9:children9040478. [PMID: 35455522 PMCID: PMC9024707 DOI: 10.3390/children9040478] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
For decades, open surgical repair was the only available method to treat congenital and acquired chest wall deformities (CWDs). In 1998, D. Nuss described a minimally invasive procedure for surgical repair of Pectus excavatum (PE). Today, the Nuss procedure is performed with increasing frequency worldwide and considered as the “gold standard”. After its introduction, the method experienced numerous modifications such as routine thoracoscopy and/or sternal elevation, increasing safety of the procedure. Placement of multiple bars and/or the so called cross-bar technique were introduced to correct complex CWDs. Standardized pain management, the introduction of cryo-analgesia and a standardized postoperative physiotherapy program including deep breathing exercises facilitate the establishment of an enhanced recovery after surgery (ERAS) process. However, the widespread use of the minimally invasive repair of pectus excavatum (MIRPE) procedure has been associated with a significant number of serious complications. Furthermore, several studies report near-fatal complications, not only during bar placement, but also during bar removal. This review focuses upon the most relevant modifications, including recent published surgical techniques of MIRPE, in order to describe current developments in the field.
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Coughlin AC, Ahsanuddin S, Inglesby D, Fox C, Xu H, Margulies I, Sayegh F, Soudant C, Sacks HS, Kaufman A, Taub PJ. "When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis". Pediatr Surg Int 2022; 38:365-375. [PMID: 35006367 DOI: 10.1007/s00383-021-05049-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The optimal age for minimally invasive repair of pectus excavatum (MIRPE) is unclear; this study investigates the differences in complication rates among different age groups undergoing repair. METHODS PubMed and Embase databases were searched from inception to October 2020. To assess age as a risk factor for complications, odds ratios from relevant studies were analyzed using the Mantel-Haenszel method with a random-effects model for younger vs older patients. Specific complication rates were compared between the two cohorts using a chi-squared test. RESULTS Of the 4448 studies retrieved, 25 studies stratified complication data by age groups. From these studies, ten studies compared groups at ages < 18 and ≥ 18 and four studies compared ages < 20 and ≥ 20, and one study compared ages < 19 and ≥ 19. These fifteen studies reported on 5978 patients, with 1188 complications, for a complication rate of 19.87%. Older patients were more likely to have complications in a pooled analysis of studies comparing older vs younger patients (OR = 1.66, 95% CI = 1.28-2.14, heterogeneity I2 = 49%). Specifically, older patients were significantly more likely to experience pneumothorax, pleural effusion, wound infection, bar displacement, and reoperations. CONCLUSION Increased age is a risk factor for complications of MIRPE. This supports repair of pectus excavatum prior to late adolescence.
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Affiliation(s)
- Arielle C Coughlin
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Sofia Ahsanuddin
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Dani Inglesby
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Conner Fox
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Hope Xu
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Ilana Margulies
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Farah Sayegh
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Celine Soudant
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Henry S Sacks
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Kaufman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter J Taub
- Division of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA.
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Song J, Wang Q, Pan Z, Wu C, Li Y, Wang G, Dai J, Xi L, Li H. The Safety and Efficacy of the Modified Single Incision Non-thoracoscopic Nuss Procedure for Children With Pectus Excavatum. Front Pediatr 2022; 10:831617. [PMID: 35211432 PMCID: PMC8861268 DOI: 10.3389/fped.2022.831617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study described and evaluated the safety and efficacy of a modified single incision non-thoracoscopic Nuss procedure in pectus excavatum (PE) children. METHODS PE patients undergoing the non-thoracoscopic Nuss procedure at the Children's Hospital of Chongqing Medical University between January 2017 and December 2020 were retrospectively enrolled. The patients were divided into two groups according to operation procedures: the double incision Nuss (DN) group and the modified single incision Nuss (SN) group. Propensity score matching (PSM) was applied before evaluation of operative and postoperative characteristics to reduce selection bias. RESULTS Of the 502 patients included, 261 were enrolled in the DN group, and 241 in the SN group. The operation time [35.0 (30.0-40.0) vs. 50.0 (40.0-55.0) minutes, P < 0.001] and postoperative inpatient stay [7.0 (6.0-8.0) vs. 7.0 (7.0-8.0) days, P < 0.001] of the patients in the SN group after PSM were significantly shorter than those of the patients in the DN group after PSM. Moreover, median blood loss was significantly less in the SN group after PSM than that in the DN group after PSM [2.0 (1.0-5.0) vs. 5.0 (2.0-5.0) ml, P < 0.001]. There were no significant differences in the incidence of complications between the two groups (P > 0.05). Bar removal was performed in 85 patients in the SN group within 24-42 months after surgery. Additionally, the SN group patients had a significantly lower Haller index (HI) after bar removal [2.36 (2.15-2.55) vs. 3.76 (3.18-4.26), P < 0.001] compared to the initial HI. CONCLUSIONS The modified procedure is safe and effective for children with PE and is worthy of clinical application.
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Affiliation(s)
- Jishuo Song
- Department of Day Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Quan Wang
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Linyun Xi
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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11
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Krstevska-Konstantinova M, Kuzevska-Maneva K, Nestorov H, Georgieva D. Association of Poland Syndrome and hypertrichosis in pubertal girl - Case report. Arch Public Health 2021. [DOI: 10.3889/aph.2021.6003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Poland syndrome (PS) is a rare congenital malformation, most commonly characterized by absence of chest wall muscles on one side of the body. It may be accompanied with other deformities of the extremities. We present the case of a 10-year-old girl with Poland syndrome and hypertrichosis of the back of the trunk and extremities. The clinical examination did not reveal the etiology of the syndrome, such as familial predisposition or some event that led to interrupted blood flow during the early embionic growth. The pregnancy was concieved with in vitro fertilization (IVF); triplets were born and our patient is one of these three girls. The hypertrychosis appeared at 8 years of life, without evidence of previous familial occurance, medications or hormonal disbalance. Other malformations that were found were: a mild form of kyphoscoliosis and mitral valve prolapse. The child was evaluated using a multidisciplinary approach, with further follow-up planned with surgical correction of the chest wall and breast augmentation.
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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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13
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Chirurgische Techniken zur Behandlung der Trichterbrust (Pectus excavatum). ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Comparison of physical functions and psychosocial conditions between adolescents with pectus excavatum, pectus carinatum and healthy controls. Pediatr Surg Int 2021; 37:765-775. [PMID: 33454849 DOI: 10.1007/s00383-021-04857-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aimed to compare the physical and psychosocial conditions of adolescents with pectus excavatum (PE) and pectus carinatum (PC), who had mild-severe deformities, with those of healthy controls (HC). METHODS This study included 180 adolescents (aged 10-18 years) with pectus deformity [PE (n = 90) and PC (n = 90)] and 90 age-matched HC. The following parameters were evaluated for each participant: clinical parameters, perceived appearance of the chest area (PAC), physical functions (grip strength, flexibility, muscle strength, endurance, physical activity), posture, psychosocial conditions, and quality of life (QOL). RESULTS Patients with PE and PC had a lower body weight, a worse, a poorer posture, lower scores for physical functions compared to the HC group (p < 0.001, all). The PE group had lower scores (p < 0.05) for some psychosocial conditions and quality of life subscales compared to the HC and PC (except for the QOL) group (p < 0.05). The PC group had a poorer posture compared to the PE group (p < 0.05). PAC was associated with physical functions and psychosocial status (r = 0.19-0.40, p < 0.05) but pectus severity was not associated with these parameters (r = 0.02-0.12, p > 0.05). CONCLUSION Our results indicate that all adolescents with mild, moderate, or severe pectus deformity should undergo a biopsychosocial evaluation, receive psychosocial support, and be referred for physiotherapy.
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Kuyama H, Uemura S, Yoshida A. Recurrence of pectus excavatum in long-term follow-up after the Nuss procedure in young children based on the radiographic Haller index. J Pediatr Surg 2020; 55:2699-2702. [PMID: 32507637 DOI: 10.1016/j.jpedsurg.2020.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/17/2020] [Accepted: 05/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE To show the changes of the thorax after bar removal in young children with pectus excavatum in long-term postoperative follow-up. METHODS A total of 173 patients who underwent Nuss procedure under the age of 10 years from January 2005 to December 2013 and underwent bar removal were retrospectively reviewed. Then, Patients who were followed-up for more than 5 years after bar removal were selected and assessed. All patients were evaluated with the Haller index (HI) by chest computed tomography before the Nuss procedure. Follow-up after bar removal was done by two-view radiography. Radiographic HI (rHI) change was evaluated from before bar removal, to immediately after bar removal, and 3 years and 5 years after bar removal. RESULTS Forty-two patients (35 boys, 7 girls) were followed-up for more than 5 years after bar removal. The average age at the Nuss procedure was 6.1 ± 1.3 years, and the average HI was 5.07 ± 1.54. The average age at bar removal was 8.5 ± 1.2 years. The average rHI was 2.47 ± 0.33 before bar removal, 2.75 ± 0.50 immediately after bar removal, 3.24 ± 0.64 at 3 years after bar removal, and 3.46 ± 0.91 at 5 years after bar removal. The rHI value increased significantly between all periods. CONCLUSIONS The Nuss procedure for young children may have the risk of recurrence during growth after bar removal. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hisako Kuyama
- Department of Pediatric Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki-City, Okayama 701-0192, Japan.
| | - Sadashige Uemura
- Department of Pediatric Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki-City, Okayama 701-0192, Japan
| | - Atsushi Yoshida
- Department of Pediatric Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki-City, Okayama 701-0192, Japan
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16
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Beltsios ET, Mitsos SL, Panagiotopoulos NT. Pectus excavatum and scoliosis: a review about the patient's surgical management. Gen Thorac Cardiovasc Surg 2020; 68:1225-1233. [PMID: 32990868 DOI: 10.1007/s11748-020-01496-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Although Nuss procedure is performed with satisfactory results, there has been a controversy in the literature regarding the effect of a Nuss procedure on the spine. This review article aims to perform an updated overview of the literature about the effect of pectus excavatum correction at the spine and the management of patients with both pectus excavatum and scoliosis. Although acquired scoliosis has been rarely reported after a Nuss procedure, studies show that the Nuss procedure can have a beneficial effect in mild coexisting scoliosis especially when it is performed during the adolescence. The management of cases presented with both pectus excavatum and scoliosis depends on the severity of pre-operative scoliosis and demands detailed evaluation of the spine pre and postoperatively. In the rare condition of post-operative scoliosis following a Nuss procedure, the removal of the metallic bar and conservative measures may have satisfactory results on the spine.
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Affiliation(s)
- Eleftherios T Beltsios
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK. .,Department of Medicine, Faculty of Health Sciences, University of Thessaly, Biopolis, 41500, Larissa, Greece.
| | - Sofoklis L Mitsos
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
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17
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Özkaya M, Bilgin M. Minimally invasive repair of the severe pectus excavatum in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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18
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Notrica DM. The Nuss procedure for repair of pectus excavatum: 20 error traps and a culture of safety. Semin Pediatr Surg 2019; 28:172-177. [PMID: 31171153 DOI: 10.1053/j.sempedsurg.2019.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In 1998, Donald Nuss changed the way the world thought about the surgical repair of pectus excavatum. The new operation adheres to sound orthopedic fundaments, but has a significantly higher learning curve than other operations in pediatric surgery. Variations in pectus excavatum type, severity, symmetry and chest wall pliability bring challenges. This article will detail common error traps and ways to avoid them when performing the Nuss procedure. As recent publications have shown, an operation done more than 50,000 times across the world may bring to light infrequent but devastating outcomes that may be preventable. The critical view of safety for pectus repair is discussed, as are areas where a culture of safety could optimize results on a larger scale. We will review potential opportunities to improve outcomes by identifying error traps in the preoperative, intraoperative, and postoperative care of patients undergoing the Nuss procedure.
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Affiliation(s)
- David M Notrica
- Department of Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, United States; Department of Surgery, Mayo Clinic College of Medicine and Science, 5757 East Mayo Boulevard, Phoenix AZ 85054, United States; Department of Child Health, University of Arizona College of Medicine Phoenix, 1919 East Thomas Road, Phoenix, AZ 85016, United States.
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20
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Sesia SB, Heitzelmann M, Schaedelin S, Magerkurth O, Kocher GJ, Schmid RA, Haecker FM. Standardized Haller and Asymmetry Index Combined for a More Accurate Assessment of Pectus Excavatum. Ann Thorac Surg 2019; 107:271-276. [DOI: 10.1016/j.athoracsur.2018.07.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/12/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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21
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Cho DG, Kim JJ, Park JK, Moon SW. Recurrence of pectus excavatum following the Nuss procedure. J Thorac Dis 2018; 10:6201-6210. [PMID: 30622792 DOI: 10.21037/jtd.2018.10.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The recurrence of pectus excavatum (PE), in other words, chest wall depression after the completion of repair, is one of the most important issues in PE. However, little about the recurrence of PE is known. The present study aimed (I) to evaluate the characteristics of chest wall depression during treatment and (II) to present the definition of recurrence of PE, investigate the risk factors for recurrence, and predict the recurrence at one year after bar removal (BR). Methods Consecutive 99 patients who had undergone BR for PE in a single hospital from March 2012 to June 2017 were included in the present study. Severity of PE is presented as a radiographical Haller index (RHI) in the present study. RHI is calculated by the ratio of the transverse diameter to the anteroposterior (AP) diameter at the point of the deepest chest wall depression. Patients with a ≥3.5 RHI value, which simultaneously increased to more than the value of RHI before BR, were considered as demonstrating recurrence in the present study. Follow-up data after BR were collected at subsequent time points (i.e., immediate before and after, one month, sixth months, and one year after BR). All postoperative chest wall changes were analyzed to find out the difference according to the age at the time of the Nuss procedure (NP) [<10 years old (early group; EG) vs. ≥10 years old (late group, LG)]. Results The mean age of patients was 8.91 (±5.23) years at the age of the NP and the mean duration of bar placement was 28.4 (±5.04) months. Seventy-eight males and 21 females were included. The pectus type was 79 symmetric and 20 asymmetric cases. The mean observation period after BR was 16.47 (±3.74) months. There was a significant correlation between the Haller index using chest CT and simple radiography data (P<0.001). Irrespective of the age groups, there were a significant decrease in RHI values after the NP (both P<0.001). In addition, there were no differences in RHI values between the EG and the LG cohort before the NP and immediately after the NP (P=0.775, P=0.356, respectively). RHI values was significantly decreased in the EG (P=0.040) and increased without a significance in the LG (P=0.330) during bar placement. The chest wall depression progressed for the first six months after BR. However, the chest wall depression did not progress one year after BR. Recurrence occurred in nine cases at one year after BR (four cases in the EG and five cases in LG). The recurrence rate was higher in the LG than in the EG without a significance (P=0.479). Multivariate analysis of the recurrence revealed that only RHI after the NP was identified as an independent risk factor of the recurrence. ROC study also showed that RHI value after the NP had a significant predictable cutoff value for the recurrence [cutoff value of RHI: 2.91, sensitivity: 88.9%, specificity: 90.0%, P<0.001, area: 0.899, 95% confidence interval (CI): 0.806-0.993]. Conclusions The present study shows the characteristics of chest wall depression and the risk factor of the recurrence of PE after BR. The effect of the NP is different according to the patient age at the time of the procedure. Early correction of PE can provide better corrective results because of the existence of a more pliable chest wall, which can be easily and sufficiently elevated by the NP. Sufficient elevation of the depressed chest wall should be ensured during the NP to prevent the recurrence of PE.
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Affiliation(s)
- Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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22
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Pulmonary function in children with Pectus excavatum and post-operative changes after nuss procedure. Pediatr Surg Int 2018; 34:1099-1103. [PMID: 30084024 DOI: 10.1007/s00383-018-4319-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to show the difference between the pulmonary function of children with mild or severe types of pectus excavatum (PE) and post-operative changes in their predicted vital capacity (%VC) following Nuss procedure. PATIENTS AND METHODS One hundred and twenty-four of the 208 children who underwent Nuss procedure for PE between January 2007 and March 2016 were deemed eligible for this study and evaluated retrospectively. A spirometry was performed on these children on four occasions: before operation; pre-bar removal; and 1 month and 1 year after bar removal. Ninety-seven of the children who were more than 7 years of age were divided using the Haller Index (HI) into a mild group (n = 54) and a severe group (n = 43) and compared. The children were also divided into three groups based on their age and their %VC was compared at each follow-up occasion. RESULTS The severe group showed a significantly lower %VC and peak expiratory flow rate than the mild group. %VC change after bar removal showed significantly lower in group aged 11 or over. 43 of the children had spirometry data recorded 1 year after bar removal which, compared with 1 month after bar removal, showed a significant higher %VC in groups aged of 10 or under. CONCLUSION Nuss procedure in children aged of 10 or under proved to be an advantage in the post-operative pulmonary function.
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Davari H, Rahim MB, Ershadi R, Rafieian S, Mardani P, Vakili MR, Shirinzadeh A. First Iranian Experience of the Minimally Invasive Nuss Procedure for Pectus Excavatum Repair: A Case Series and Literature Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:554-559. [PMID: 30214110 PMCID: PMC6123557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Pectus excavatum is the most common congenital deformity of the chest wall. The most frequently used techniques include Ravitch (costochondral resection) and Nuss (minimally invasive pectus repair of pectus excavatum [MIRPE]). The Nuss technique includes using temporary metallic bars without costochondral resection to correct the chest wall deformity. Modified MIRPE can be learned easily and performed safely with few complications. There are no reports of successful MIRPE in Iran, although the Ravitch technique is well known. In the present study, we report the first Iranian experience with the modified Nuss procedure in 5 patients with pectus excavatum (age range=13-48 y). All the patients suffered from low self-esteem, and one of them complained of low exercise capacity and occasional chest pain. With single-lung ventilation and sternal elevation, an introducer was entered into the right thoracic cavity and retrosternal tunneling was performed under thoracoscopic vision. The introducer was passed to the left thoracic cavity and exited on the left thoracic wall. A titanium plate bar was implanted and fixed with stabilizers. There were no cases of mortality, and all the patients were discharged in good conditions within 2 weeks. Postoperative complications consisted of 1 case of pneumothorax and 2 cases of fixed bar protrusion. The present case series indicated that a skilled thoracoscopic surgeon is able to do the Nuss procedure in Iranian patients with symmetrical pectus excavatum with few complications. However, mixed or redo cases require more expertise.
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Affiliation(s)
- Hamidreza Davari
- General Thoracic Surgeon, General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran Iran;
| | - Mohammad Bagher Rahim
- General Thoracic Surgeon, General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran Iran;
| | - Reza Ershadi
- General Thoracic Surgeon, General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran Iran;
| | - Shahab Rafieian
- General Thoracic Surgeon, General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran Iran;
| | - Parviz Mardani
- General Thoracic Surgeon, General Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Rahim Vakili
- General Thoracic Surgeon, General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran Iran;
| | - Ahmad Shirinzadeh
- General Thoracic Surgeon, General Thoracic Surgery Ward, Tehran University of Medical Sciences, Tehran Iran;
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Notrica DM. Modifications to the Nuss procedure for pectus excavatum repair: A 20-year review. Semin Pediatr Surg 2018; 27:133-150. [PMID: 30078484 DOI: 10.1053/j.sempedsurg.2018.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David M Notrica
- Department of Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, United States; Mayo Clinic College of Medicine, United States; University of Arizona College of Medicine Phoenix, United States .
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25
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Abstract
Pectus excavatum is the most common chest wall deformity in children. The central portion of the chest is displaced posteriorly relative to the remainder of the anterior chest wall. Quantification of defect severity can be performed with multiple imaging modalities or external thoracic measures, but is most commonly quantified by the Haller Index (HI) or Pectus Correction Index (PCI). These two measures provide a measure of the chest based on cross sectional imaging, most commonly CT scans, allowing for standard comparison and definitions of pectus defects. The purpose of this article is to describe the creation, calculation, and limitations of the methods quantifying pectus defects.
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Affiliation(s)
- Joseph A Sujka
- Thomas Holder and Keith Aschraft Endowed Chair, The Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, United States
| | - Shawn D St Peter
- Thomas Holder and Keith Aschraft Endowed Chair, The Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, United States.
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Gui L, Shen S, Mei W. Anaesthesia for chest wall reconstruction in a patient with Poland syndrome: CARE-compliant case report and literature review. BMC Anesthesiol 2018; 18:57. [PMID: 29793431 PMCID: PMC5968485 DOI: 10.1186/s12871-018-0518-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poland syndrome is a rare congenital disease, characterized by agenesis/hypoplasia of the pectoralis major muscle, usually associated with variable thoracic anomalies that needed chest wall reconstruction under general anesthesia. Anaesthetic management in Poland syndrome has scarcely been described. CASE PRESENTATION Here, we present our anaesthetic management of Nuss procedure for chest wall correction in a 5 years old patient with Poland syndrome. We also reviewed the reports of anaesthetic management of Poland syndrome by searching Pubmed, and summarize the perioperative procedures that may warrant a safe surgery. CONCLUSIONS Examinations before surgery, intraoperative monitoring, choice of general anesthetics and pain management after surgery should all be contemplated.
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Affiliation(s)
- Lingli Gui
- Department of Anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China
| | - Shiqian Shen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachsetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02129, USA
| | - Wei Mei
- Department of Anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China.
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Dore M, Triana Junco P, De La Torre C, Vilanova-Sánchez A, Bret M, Gonzalez G, Nuñez Cerezo V, Jimenez Gomez J, Luis Encinas J, Hernandez F, Martínez Martínez L, Lopez Santamaria M. Nuss Procedure for a Patient with Negative Haller Index. European J Pediatr Surg Rep 2018; 6:e18-e22. [PMID: 29473012 PMCID: PMC5820059 DOI: 10.1055/s-0038-1623537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/14/2017] [Indexed: 10/29/2022] Open
Abstract
Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed. All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.
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Affiliation(s)
- Mariela Dore
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Paloma Triana Junco
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Carlos De La Torre
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | | | - Monserrat Bret
- Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Gaspar Gonzalez
- Department of Pediatric Traumatology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Vanesa Nuñez Cerezo
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Javier Jimenez Gomez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jose Luis Encinas
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Francisco Hernandez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
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Park HJ, Kim JJ, Park JK, Moon SW. Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum. J Thorac Dis 2017; 9:3810-3816. [PMID: 29268389 DOI: 10.21037/jtd.2017.08.128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The objectives of this study are to investigate the association between pectus excavatum (PE) and thoracic scoliosis (TS) and to analyze the effects of the Nuss procedure on the thoracic spinal curvature in patients with PE. Methods A total of 468 patients who underwent the Nuss procedure and pectus bar removal for PE from March 2011 to January 2015 were assessed and included into the present study. Results TS prevalence was 9.4% pre-correctively and 9.8% post-correctively. There was a positive correlation between age and Cobb angle (CA), pre-correctively and post-correctively (both, P<0.001). The late correction group (LG, age ≥10 years) had a higher CA and more frequent TS than the early correction group (EG, age <10 years) (pre-correction: CA 6.3±4.9° vs. 4.5±3.8°, P<0.001, TS P<0.001; post-correction: 7.6±7.2° vs. 4.1±3.3°, P<0.001, TS P<0.001). The post-corrective changes in CA were different according to the time of correction (decreased in EG: 4.5±3.8° vs. 4.1±3.3°, P=0.078; increased in LG: 6.3±4.9° vs. 7.6±7.2°, P=0.002). In patients with pre-corrective TS, CA after correction was decreased (post-correctively 11.9±10.0° vs. pre-correctively 13.9±6.0°, P=0.090). In addition, post-corrective CA was significantly decreased in EG (pre-correction 13.9±7.4° vs. post-correction 6.6±8.1°, P<0.001). However, post-corrective CA was increased in LG (pre-correction 13.8±4.5° vs. post-correction 16.7±9.2°, P=0.053). The number of patients with TS after correction was decreased in EG (P=0.194) and significantly increased in LG (P=0.028). There were both pre-corrective and post-corrective predictive factors for TS (Pre-corrective: age P<0.001, severity P=0.016, and BMI P=0.046; post-corrective: age at the time of correction P<0.001, weight P=0.046, and pre-corrective CA P<0.001). Conclusions The Nuss procedure had some significant effects on the thoracic spinal curvature, with early correction able to reduce TS in patients with PE.
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Affiliation(s)
- Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's University of Korea, Seoul, Republic of Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's University of Korea, Seoul, Republic of Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's University of Korea, Seoul, Republic of Korea
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Shaalan AM, Kasb I, Elwakeel EE, Elkamali YA. Outcome of surgical repair of Pectus Excavatum in adults. J Cardiothorac Surg 2017; 12:72. [PMID: 28851442 PMCID: PMC5576375 DOI: 10.1186/s13019-017-0635-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/24/2017] [Indexed: 11/16/2022] Open
Abstract
Background Pectus Excavatum (PEx) is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities. Surgical correction is recommended because severe PEx can affect the physical and psychological development of patients. The aim of our study was to assess the impact of surgical repair of Pectus Excavatum in adults during hospital course and results after 1 year. Methods Prospective study was carried out on 86 adult patients aged ≥ 15 years, 52 males and 34 females (mean age was 26 ± 1.5 years). All cases were divided into two groups, group I: (15–25 years old) and group II: (> 25 years old). Preoperative, operative, and postoperative data were reviewed. Statistical analysis was performed. Results Statistical analyses revealed significant improvement postoperatively of cosmetic satisfaction (P-value < 0.0001), pain (P-value =0.0003), exertional dyspnea (p-value <0.05) and exercise tolerance. The degree of chest compression was significantly improved after surgical correction within 12 months and the estimated measurement postoperatively of Haller Index showed significant reduction (p-value <0.001). Patient satisfaction postoperatively was excellent in 77.9% of all cases. Conclusion Surgical correction of Pectus Excavatum using open technique in adults had excellent post-operative outcome in the short term follow up that encourage performing the procedure for all cases. Long term results need longer period for follow up. Etiology and predisposing factors still need further research.
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Affiliation(s)
- Ayman M Shaalan
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt. .,Dallah Hospital, Cardiac Center, Riyadh, Saudi Arabia.
| | - Ibrahim Kasb
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Eman E Elwakeel
- Anatomy and Embryology Department, Benha University, Benha, Egypt
| | - Yusra A Elkamali
- Statistics Department, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
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Masahata K, Yoneyama C, Tsukada R, Toyama C, Ibuka S, Nara K, Soh H, Usui N. Nuss procedure for a case of asymmetric pectus excavatum associated with Ehlers-Danlos syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Facchini F, Ghionzoli M, Martin A, Tanini S, Ugolini S, Lo Piccolo R, Messineo A. Regenerative Surgery in the Treatment of Cosmetic Defect Following Nuss Procedure. J Laparoendosc Adv Surg Tech A 2017; 27:748-753. [DOI: 10.1089/lap.2016.0217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Flavio Facchini
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Alessandra Martin
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Sara Tanini
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Sara Ugolini
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
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Complications after pectus excavatum repair using pectus bars in adolescents and adults: risk comparisons between age and technique groups†. Interact Cardiovasc Thorac Surg 2017; 25:606-612. [DOI: 10.1093/icvts/ivx162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 11/14/2022] Open
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Pilegaard H, Licht PB. Minimal Invasive Repair of Pectus Excavatum and Carinatum. Thorac Surg Clin 2017; 27:123-131. [DOI: 10.1016/j.thorsurg.2017.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Li S, Yang D, Ma Y, Tang ST, Yang L, Li S, Cao G, Li K, Zhang X, Hu X. Hybrid Nuss Procedure for Pectus Excavatum With Severe Retrosternal Adhesions After Sternotomy. Ann Thorac Surg 2017; 103:1573-1577. [DOI: 10.1016/j.athoracsur.2016.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/28/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Sengul AT, Buyukkkarabacak YB, Altunkaynak BZ, Yetim TD, Altun GY, Sengul B, Basoglu A. Effects of platelet-rich plasma on cartilage regeneration after costal cartilage resection: a stereological and histopathological study. Acta Chir Belg 2017; 117:21-28. [PMID: 27487267 DOI: 10.1080/00015458.2016.1210874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In cases of congenital chest wall deformities, it is important to maintain the flexibility of the chest wall after rib cartilage resection. In this study, we aimed to determine the regeneration capability of cartilage and the effects of platelet-rich plasma (PRP) on the regeneration process. METHODS A total of 16 four-week-old New Zealand rabbits were used in this study. In the 4th-5th right costal cartilages, the perichondrial sheaths were dissected and costal cartilages were excised. Then, the perichondrial sheaths were closed with absorbable material in the sham group (n = 8), and this was done after replacing PRP in the PRP group (n = 8). The left costal cartilages of the animals were used as controls. The volumes of the costal cartilages and their perichondrial sheaths were estimated using Cavalieri's principle. In addition, the mean numerical densities of the chondroblasts and chondrocytes per square millimetre were estimated using unbiased counting frames. RESULTS In the PRP and sham groups, the volumes of the cartilages and perichondrial sheaths were higher than those of the control group (p < 0.05). The numerical densities of the chondroblasts and chondrocytes increased more in the PRP group than in the sham group (p < 0.05). CONCLUSIONS Applying PRP after resection may provide better healing and faster regeneration of cartilage.
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Kim HK, Yoon JY, Han KN, Choi YH. Effect of the Nuss Procedure on the Physical Development of Patients with Pectus Excavatum. Ann Thorac Cardiovasc Surg 2016; 22:327-332. [PMID: 27629820 DOI: 10.5761/atcs.oa.16-00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study assessed physical development of patients with pectus excavatum and evaluated the effect of the Nuss procedure on physical development. METHODS A total of 146 patients underwent the Nuss procedure; of these, at the time of the study, the bar had been removed from 123 patients (84.9%; male 93, female 30) who were eligible for participation in this study. Heights and body weights of patients were measured prior to surgery and immediately before bar removal. Chest computed tomography (CT) was performed preoperatively and immediately before bar removal. The associations between physical development and chest CT indices were evaluated. RESULTS The height standard deviation score (SDS) was - 0.66 ± 2.23 preoperatively and 0.04 ± 1.34 immediately before bar removal (p <0.01). The weight SDS was - 0.02 ± 2.59 preoperatively; it increased significantly to 0.56 ± 1.56 immediately before bar removal (p <0.01). The Haller index (3.85 ± 1.18 to 2.99 ± 0.54; p <0.01) and asymmetric index (9.75 ± 6.63 to 7.01 ± 4.77; p <0.01) also showed improvements. CONCLUSIONS The Nuss procedure may contribute positively to the physical development of patients with pectus excavatum.
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Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Ghionzoli M, Martin A, Bongini M, Bongini U, Ciuti G, Grisotto L, Monaco V, Menciassi A, Defilippi C, Messineo A. Scoliosis and Pectus Excavatum in Adolescents: Does the Nuss Procedure Affect the Scoliotic Curvature? J Laparoendosc Adv Surg Tech A 2016; 26:734-9. [DOI: 10.1089/lap.2016.0168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marco Ghionzoli
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Alessandra Martin
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Martina Bongini
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Ubaldo Bongini
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - Laura Grisotto
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - Claudio Defilippi
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Antonio Messineo
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
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Choi JH, Park IK, Kim YT, Kim WS, Kang CH. Classification of Pectus Excavatum According to Objective Parameters From Chest Computed Tomography. Ann Thorac Surg 2016; 102:1886-1891. [PMID: 27526652 DOI: 10.1016/j.athoracsur.2016.05.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous classification systems of pectus excavatum have been based on subjective morphologic characteristics. We sought to suggest a new classification system derived from objective variables. METHODS Patients who underwent surgical repair of pectus excavatum without a history of previous chest operations were included. Objective morphologic variables were measured from chest computed tomography scan images, and classification was performed by hierarchical clustering of measured indexes. Clinical relevance of the suggested classification was also verified. RESULTS Included were 230 patients who underwent operation for pectus excavatum from January 2001 to August 2013. These patients were classified into two major groups: typical (group I; 197 [85.7%]) and atypical (group II; 33 [14.3%]). Group I was further classified into three subgroups according to flatness and symmetry of the chest wall. Group II was further classified into four subgroups according to the severity of sternal torsion and sternal angulation. Two unique types of deformity were identified in group II: the double distortion subgroup (group IIa; 8 [3.5%]) and the reverse torsion subgroup (group IIc; 16 [7.0%]). Scoliosis was more frequently associated with group IIa (p = 0.008). CONCLUSIONS Morphologic classification obtained from computed tomography indexes hierarchical clustering identified seven distinct subtypes of pectus excavatum.
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Affiliation(s)
- Jin-Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Sun Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
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Early and Late Results of the Nuss Procedure in Surgical Treatment of Pectus Excavatum in Different Age Groups. Ann Thorac Surg 2016; 102:1711-1716. [PMID: 27373189 DOI: 10.1016/j.athoracsur.2016.04.098] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was a comparison of early and late results in surgical treatment of funnel chest using the Nuss method in patients in various age groups to find the optimal age to perform the corrective procedure. METHODS Six hundred eighty patients operated on from June 2002 to October 2012 were included in the retrospective analysis. Patients were divided into 3 different age groups: group A = 156 patients from 7 to 14 years, group B = 328 patients aged 15 to 20 years, and group C = 196 patients older than 20 years of age. The mean follow-up was 33 months. RESULTS Early non-life-threatening complications developed in 238 (35.0%) patients and frequency increased with age (group A, 24.3%; group B, 37.8%; group C, 38.8%; p = 0.0063). Good and very good corrective effects were achieved in 97.7 % of the entire patient population. Recurrence of the deformity was observed more often in younger patients (group A, 3.2 %) than in the other patients (group B, 1.2%; group C, 1.5%), although the difference between the studied groups was not significant (p = 0.3251). CONCLUSIONS Good cosmetic results obtained with the use of the Nuss operation were not related to the age of the patients. The high incidence of minor complications in older patients seems to be an acceptable cost of a good cosmetic outcome and stable correction. Surgical morbidity is lowest in younger patients; however, the frequency of the recurrence of deformation is higher than in other groups.
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Park HJ, Kim JJ, Park JK, Moon SW. A cross-sectional study for the development of growth of patients with pectus excavatum. Eur J Cardiothorac Surg 2016; 50:1102-1109. [PMID: 27165768 DOI: 10.1093/ejcts/ezw162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 03/19/2016] [Accepted: 04/11/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pectus excavatum is one of the most common congenital chest wall deformities, and is thought to be one of the musculoskeletal diseases. There have been few studies on the development of growth of patients with pectus excavatum. The objectives of the present study were to present the development of growth of patients with pectus excavatum and to investigate the effects of the Nuss procedure on the development of growth. METHODS Data from 1371 patients who were treated for pectus excavatum (411 patients for only the Nuss procedure, 316 patients for only bar removal and 322 patients for both the Nuss procedure and the bar removal) at the Department of Thoracic and Cardiovascular Surgery in a single tertiary Korean Hospitals from March 2011 to December 2014 were assessed with respect to body measurements [height, weight and body mass index (BMI)]. Anthropometric measurements and developmental data and deviations of a reference population were analysed by the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-3), 2011-2013, Korea Centers for Disease Control and Prevention. To analyse the development of growth in patients with pectus excavatum, we performed (i) comparisons of body measurements between patients with pectus excavatum and the normal population, (ii) analyses of postoperative changes in the body measurements and (iii) analyses of the body measurements with respect to age at surgery, morphology and severity. RESULTS (i) Body measurements of the preoperative group (PreG, patients for the Nuss procedure) were significantly smaller than those of the normal control group (NCG) (height 139.2 ± 0.4 vs 140.7 ± 0.0, weight 37.4 ± 0.3 vs 39.6 ± 0.0, BMI 17.5 ± 0.1 vs 18.6 ± 0.0, all P < 0.001). Weight and BMI of the postoperative group (PostG, patients for pectus bar removal) were also significantly smaller than those of NCG (weight 36.6 ± 0.4 vs 39.6 ± 0.0, BMI 17.4 ± 0.1 vs 18.6 ± 0.0, both P < 0.001). However, height of PostG was not significantly different from that of NCG. In addition, height and BMI of PostG were larger than those of PreG (height 131.2 ± 0.3 vs 130.4 ± 0.3, P < 0.001; BMI 16.7 ± 0.1 vs 16.6 ± 0.1, P = 0.143). However, weight of PostG was significantly smaller than that of PreG (30.4 ± 0.2 vs 30.9 ± 0.2, P = 0.005). (ii) The severity of pectus excavatum was defined by the Haller index and the patients were divided into two groups by the mean value of the Haller index (4.3 ± 1.53). Preoperatively, weight and BMI of the high severity group (HG) were significantly smaller than those of the low severity group (LG) (weight 28.2 ± 0.3 vs 29.1 ± 0.2, P = 0.029; BMI 16.2 ± 0.1 vs16.6 ± 0.1, P = 0.008); however, height of HG was not significantly different from that of LG. Postoperatively, body measurements of HG were not significantly different from those of LG. In addition, severity of pectus excavatum was not correlated to age. (iii) Preoperatively, body measurements of the symmetric group (SG) were not different from those of the asymmetric group (AG). However, asymmetric type was more common in the older group (10.8 ± 5.7 vs 6.7 ± 5.0 years, P < 0.001). In addition, body measurements of SG were not different from those of AG postoperatively. (iv) Body growth after the surgery was more prominent in the early (age <10 years: height 112.4 ± 0.3 vs113.1 ± 0.4, P = 0.016, weight 20.2 ± 0.1 vs 20.2 ± 0.3, P = 0.053, BMI 15.7 ± 0.2 vs 15.8 ± 0.1, P = 0.007) than the late operation group (age ≥10 years: height 167.7 ± 0.5 vs 167.0 ± 0.6, P < 0.001, weight 51.2 ± 0.5 vs 51.8 ± 0.5, P = 0.536, BMI 18.1 ± 0.1 vs 18.3 ± 0.1, P = 0.078). CONCLUSIONS Development of growth in patients with pectus excavatum is retarded and appears to be related to the severity of pectus excavatum. The development of growth can be recovered by early correction of the deformity.
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Affiliation(s)
- Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
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Sacco Casamassima MG, Gause C, Goldstein SD, Karim O, Swarup A, McIltrot K, Yang J, Abdullah F, Colombani PM. Patient Satisfaction After Minimally Invasive Repair of Pectus Excavatum in Adults: Long-Term Results of Nuss Procedure in Adults. Ann Thorac Surg 2016; 101:1338-45. [DOI: 10.1016/j.athoracsur.2015.09.102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/18/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022]
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Iwanaka T, Yamataka A, Uemura S, Okuyama H, Segawa O, Nio M, Yoshizawa J, Yagi M, Ieiri S, Uchida H, Koga H, Sato M, Soh H, Take H, Hirose R, Fukuzawa H, Mizuno M, Watanabe T. Pediatric Surgery. Asian J Endosc Surg 2015; 8:390-407. [PMID: 26708583 DOI: 10.1111/ases.12263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/25/2022]
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Comments on the article "Clinical application of Nuss procedure for chest wall deformity in Poland syndrome". POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 11:424. [PMID: 26336461 PMCID: PMC4349046 DOI: 10.5114/kitp.2014.47344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Park HJ, Kim KS, Moon YK, Lee S. The bridge technique for pectus bar fixation: a method to make the bar un-rotatable. J Pediatr Surg 2015; 50:1320-2. [PMID: 25783318 DOI: 10.1016/j.jpedsurg.2014.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/28/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Pectus bar rotation is a major challenge in pectus repair. However, to date, no satisfactory technique to completely eliminate bar displacement has been introduced. Here, we propose a bar fixation technique using a bridge that makes the bar unmovable. The purpose of this study was to determine the efficacy of this bridge technique. METHODS A total of 80 patients underwent pectus bar repair of pectus excavatum with the bridge technique from July 2013 to July 2014. The technique involved connecting 2 parallel bars using plate-screws at the ends of the bars. To determine bar position change, the angles between the sternum and pectus bars were measured on postoperative day 5 (POD5) and 4 months (POM4) and compared. RESULTS The mean patient age was 17.5 years (range, 6-38 years). The mean difference between POD5 and POM4 were 0.23° (P=.602) and 0.35° (P=.338) for the upper and lower bars, respectively. Bar position was virtually unchanged during the follow-up, and there was no bar dislocation or reoperation. CONCLUSIONS A "bridge technique" designed to connect 2 parallel bars using plates and screws was demonstrated as a method to avoid pectus bar displacement. This approach was easy to implement without using sutures or invasive devices.
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Affiliation(s)
- Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul 137-701, Korea.
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul 137-701, Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul 137-701, Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, College of Medicine, Yonsei University, 211 Eunjoo-Ro, Gangnam -Gu, Seoul 135-720, Korea
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Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience. J Thorac Dis 2015; 7:S172-6. [PMID: 25984364 DOI: 10.3978/j.issn.2072-1439.2015.04.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/27/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pectus excavatum (PE) is the most common anomaly of the anterior chest wall. Prior PE was corrected by a modified Ravitch operation, but since Nuss published his minimal technique in 1998, most surgeons have preferred this technique. METHODS Since 2001 the modified Nuss procedure has routinely been used for correction of more than 1,500 patients at Aarhus University Hospital. In the time period between January 1, 2011 and January 31, 2015, 675 patients have been corrected. The median age was 16 years (range, 11-58 years). All patients had preoperatively an epidural catheter and the operations were done in general anaesthesia. The postoperative pain treatment was planned for 4-5 weeks and the patients were routinely seen in the outpatient clinic 6 weeks after surgery and the bars removed after 3 years. RESULTS Four hundred-and-fifty patients had one bar, 216 patients with two bars and nine patients with three bars inserted. The median length of the bar was 10 inch. The median duration of the operation was 29 minutes. The median postoperative stay was 3 days. No death, cardiac perforation or deep infection occurred and only 5% of the patients experienced a complication. CONCLUSIONS The Nuss procedure should still be considered in the treatment of PE. To my opinion, it should be the choice for correction of PE. The short bar should be used to achieve the best stability of the system, to obtain a good cosmetic result, a reduced dysfunction motion of the chest wall and an increased cardiac performance.
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Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Denmark
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Minimally invasive repair of pectus excavatum: analyzing contemporary practice in 50 ACS NSQIP-pediatric institutions. Pediatr Surg Int 2015; 31:493-9. [PMID: 25814003 DOI: 10.1007/s00383-015-3694-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Minimally invasive repair of pectus excavatum (MIRPE) is a well-established procedure. However, morbidity rate varies widely among institutions, and the incidence of major complications remains unknown. STUDY DESIGN The American College of Surgeons 2012 National Surgical Quality Improvement Program-Pediatric (NSQIP-P) participant user file was utilized to identify patients who underwent MIRPE at 50 participant institutions. Outcomes of interest were overall 30-day morbidity, hospital readmission, and reoperation. RESULTS Chest wall repair designated MIRPE accounted for 0.6% (n = 264) of all surgical cases included in the NSQIP-P database in 2012. The median age at surgical repair was 15.2 years. Thoracoscopy was used in 83.7% of cases. No mediastinal injuries or perioperative blood transfusions were identified. The 30-day readmission rate was 3.8%. Three patients (1.1%) required re-operation due to the following complications: superficial site infection, bar displacement and pneumothorax. The overall morbidity was 3.8% with no incidences of mortality. CONCLUSIONS This analysis of a large prospective multicenter dataset demonstrates that major complications following MIRPE are uncommon in contemporary practice. Wound infection is the most common complication and the main cause of hospital readmission. Targeted quality improvement initiative should be focused on perioperative strategy to further reduce wound occurrences and hospital readmission.
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Radiologic factors related to double-bar insertion in minimal invasive repair of pectus excavatum. World J Pediatr 2015; 11:148-53. [PMID: 25416004 DOI: 10.1007/s12519-014-0522-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 01/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pectus excavatum is the most common congenital chest wall deformity, with a high incidence in live births. This study aimed to evaluate the measured factors on CT images related to the number of pectus bars for surgical correction. METHODS A total of 497 patients who had undergone minimally invasive repair between April 2007 and July 2011 were classified into single-bar (n=358) and double-bar (n=139) insertion groups. We measured eight distinct distances and one angle on CT scans to reflect quantitative assessment. Univariate analysis and multivariate logistic regression analysis were performed to detect statistically significant association between radiologic measurements and the pectus bars required. RESULTS After adjusting for age and gender, the transverse distance (T), the transverse distance of the depression area (A), the inclined distance of the depression area (B), the AP distance of the depression area (C), the depression angle (G), and the eccentric distance of deformity (E) were significantly correlated with double-bar insertion. The regression model showed that age (P<0.0001), gender (P<0.0001), depression angle (G) (P<0.0001), direction of the depression (DD) (P<0.0001) and depression depth (D) (P<0.0001) were significantly associated with double-bar insertion. CONCLUSION CT scan provides useful factors which can be of assistance in predicting the number of pectus bars for the surgical correction of pectus excavatum.
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Araújo MEDA, Penha ADP, Westphal FL, Silva MT, Galvão TF. Nuss procedure for pectus excavatum repair: critical appraisal of the evidence. Rev Col Bras Cir 2015; 41:400-5. [PMID: 25742405 DOI: 10.1590/0100-69912014006004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/28/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence. METHODS We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83). CONCLUSION In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.
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Affiliation(s)
| | | | | | | | - Taís Freire Galvão
- Getúlio Vargas University Hospital, Federal University of Amazonas, AM, Brazil
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