Pectus Bar Removal After Minimal Invasive Repair of Pectus Excavatum: Advantages of Bar Stabilizer Anvil Tool

Introduction. Nuss procedure is a minimal invasive surgical technique based on retrosternal placement of a metal plate to correct pectus excavatum chest deformity. We are presenting our five?year (2006?2011) institutional experience of 21 patients. Objective. The aim of this study was to determine characteristics and advantages of minimal invasive surgical approach in correcting deformities of the chest. Methods. Surgical procedure, named after its author Nuss, involves the surgical placement of a molded metal plate, the so?called pectus bar, behind the sternum under thoracoscopic view whereby immediate controlled intraoperative corrections and stabilizations of the depression can be made. The great advantage of this method is reflected in a significant shortening of operative time, usually without indications for compensation in blood volume, and with a significantly shortened postoperative recovery that allows patients to quickly return to their normal activities. Results. In the period 2006?2011, 21 patients were operated by the Nuss procedure. The pectus bar was set in front or behind the muscles of the chest. Among the complications listed were inflammation of wounds in three patients, dislocation (shifting) of the bar requiring a reoperation in two patients, an occurrence of a pericardial effusion in one patient, and allergic response to foreign body in one patient. Five patients required extraction of the bar two years later, and three patients after three years, all with excellent results. Conclusion. Minimally invasive Nuss procedure is safe and effective. It currently represents the primary method of choice for solving the chest deformity pectus excavatum for patients of all ages. Modification of thoracoscopic control allows a safe field of operation. Postoperative results are excellent with very few complications that can be attributed to the learning curve.

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Life-Threatening Complication after Pectus Excavatum Repair due to Malposition of the Metal Pectus Bar in the Pericardial Sac

10.1055/s-0040-1705551 ◽

2020 ◽

Author(s):

K. Rubarth ◽

R. Cesnjevar ◽

M. Cuomo ◽

S. Dittrich ◽

M. Schöber

Keyword(s):

Pectus Excavatum ◽

Life Threatening ◽

Pectus Bar ◽

Life Threatening Complication

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Pectus excavatum repair using bridge fixation system

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319846733 ◽

2019 ◽

Vol 27 (5) ◽

pp. 374-380

Author(s):

Vu Huu Vinh ◽

Huynh Quang Khanh ◽

Nguyen Hoang Binh ◽

Nguyen Van Khoi

Keyword(s):

Postoperative Complications ◽

Pectus Excavatum ◽

Fixation Method ◽

Fixation Techniques ◽

Pectus Bar ◽

Skin Surgery ◽

The Stability ◽

Skin To Skin ◽

Average Skin ◽

Fixation System

Background The stability of the pectus bar is an important determinant of the success of pectus excavatum repair surgery. In practice, several different types of fixation method are in use for stabilizing pectus bars. The aim of this study was to compare the performance of the bridge fixation system with previous fixation systems for stabilizing pectus bars. Methods We performed a retrospective review of 1760 pectus excavatum repair cases conducted in the Thoracic Department of Choray Hospital and its satellite hospitals, between 2007 and 2017. We compared the results of 560 patients who had the bridge fixation system with the previous 1200 patients who had other fixation techniques. Results The bridge fixation system with 2 bars in 560 patients gave better results in terms of bar stabilization, operative time, and postoperative complications, compared to the previous 1200 patients who had other stabilization techniques. The average skin-to-skin surgery time using the bridge fixation system was 55 min. Of the 560 cases, only one patient showed trivial one bar dislocation, and one had a postoperative complication (pneumothorax). Conclusions We found the bridge fixation system to be superior not only in terms of stabilizing the bars but also for minimizing the time of surgery and postoperative complications, compared to other fixation systems. The bridge fixation system with 2 bars showed excellent results. Use of 3 bars is not necessary. One bar was used in the other fixation techniques and the results were found to be inferior compared to those using 2 bars.

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Sternal elevation techniques during the minimally invasive repair of pectus excavatum

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz142 ◽

2019 ◽

Vol 29 (4) ◽

pp. 497-502 ◽

Cited By ~ 1

Author(s):

Frank-Martin Haecker ◽

Thomas Krebs ◽

Gregor J Kocher ◽

Ralph A Schmid ◽

Sergio B Sesia

Keyword(s):

Side Effects ◽

Minimally Invasive ◽

Pectus Excavatum ◽

Skin Incision ◽

Technical Equipment ◽

Nuss Procedure ◽

Review Of The Literature ◽

Different Types ◽

Pectus Bar ◽

Number Of Authors

Summary The aim of the review was to evaluate the routine use of sternal elevation techniques (SETs) during minimally invasive repair of pectus excavatum (MIRPE, the Nuss procedure). We performed a review of the literature between January 1998 and September 2018 with focus on different methods of SET during MIRPE. Reported effects and side effects were evaluated and compared with our own experience concerning the routine use of the vacuum bell for sternal elevation during MIRPE during the last 13 years. SET is more often used in adult patients than in adolescents. SET improves visualization and safety of MIRPE. Advancement of the pectus introducer, retrosternal dissection and placement of the pectus bar are easier. The risk of cardial and/or pericardial lesion is reduced significantly. Different types of retractors, a crane combined with a wire and/or customized hooks are reported to be used as SET. Furthermore, routine use of a subxiphoid incision is reported. However, more technical equipment, and in some SETs additional incisions are necessary. In contrast, no additional skin incision is necessary for the vacuum bell. The routine intraoperative use of the vacuum bell was safe and effective in 131 patients. It facilitates the retrosternal dissection and the insertion of the pectus bar like other SETs. Besides a temporary mild hematoma, no relevant side effect was observed. In conclusion, an increasing number of authors report on the routine use of SET during MIRPE to improve safety of the procedure. We recommend the routine intraoperative use of the vacuum bell during MIRPE.

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The Predictive Value of Haller Index in Patients Undergoing Pectus Bar Repair for Pectus Excavatum

Journal of Surgical Research ◽

10.1016/j.jss.2011.02.014 ◽

2011 ◽

Vol 170 (1) ◽

pp. 104-106 ◽

Cited By ~ 18

Author(s):

Vincent E. Mortellaro ◽

Corey W. Iqbal ◽

Frankie B. Fike ◽

Susan W. Sharp ◽

Daniel J. Ostlie ◽

...

Keyword(s):

Predictive Value ◽

Pectus Excavatum ◽

Haller Index ◽

Pectus Bar

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Correction of Pectus Excavatum With Breast Hypoplasia Using Simultaneous Pectus Bar Procedure and Augmentation Mammoplasty

Annals of Plastic Surgery ◽

10.1097/sap.0b013e31826a1a93 ◽

2014 ◽

Vol 73 (2) ◽

pp. 190-195 ◽

Cited By ~ 7

Author(s):

Hyung Joo Park ◽

Ja Hea Gu ◽

Joon Chul Jang ◽

Eun-Sang Dhong ◽

Eul-Sik Yoon

Keyword(s):

Pectus Excavatum ◽

Augmentation Mammoplasty ◽

Breast Hypoplasia ◽

Pectus Bar

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Internal Mammary Artery Compression After Pectus Excavatum Repair Does Not Increase Risk of Hemorrhagic Complications in Pediatric Patients

Frontiers in Pediatrics ◽

10.3389/fped.2020.619065 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tamás Kovács ◽

Gyula Pásztor ◽

Anna Rieth

Keyword(s):

Pectus Excavatum ◽

Internal Mammary Artery ◽

Study Data ◽

Minimal Invasive ◽

Nuss Procedure ◽

Vascular Changes ◽

Mammary Arteries ◽

Hemorrhagic Complications ◽

Increase Risk ◽

Internal Mammary

Objectives: Minimal invasive repair of pectus excavatum (MIRPE) described by Nuss is the most popular correction nowadays of this deformity. During the introduction of the bars, they can hurt or compress the internal mammary arteries (IMA). The aim of this study was to observe the prevalence of IMA compression in children after MIRPE. Also, we examined if IMA obstruction increases the risk of complications at bar removal, and if these vascular changes are reversible.Materials and Methods: All patients operated on pectus excavatum in our tertiary pediatric surgical center between 2013 and 2019 were involved in the study. Data of age, sex, number of bars and characteristics of the deformity were examined. IMA flow was checked by Doppler ultrasound (DUS) after MIRPE and after bar removal, too.Results: Among 41 patients with mean age of 15.2 years there were 18 asymmetrical deformities, 23 sternal rotations. Mean pectus index was 4.01. After the Nuss procedure 7(9%) stenoses and 10(12%) occlusions of IMA were found on DUS. After bar removal 3 of 4 stenoses have resolved, but all examined occlusions (3/3) persisted. There were no complications during bar removals.Conclusion: IMA compression after MIRPE in children is uncommon, and is not influenced by severity of deformity. Obstruction of these vessels does not increase the risk of hemorrhagic complications at bar removal. Data of larger cohort are needed to determine reversibility of these changes.

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