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

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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Effects of Pectus Excavatum on the Spine of Pectus Excavatum Patients with Scoliosis

Journal of Healthcare Engineering ◽

10.1155/2017/5048625 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

WeiHong Zhong ◽

JinDuo Ye ◽

JingJing Feng ◽

LiYang Geng ◽

GuangPu Lu ◽

...

Keyword(s):

Torsion Angle ◽

Pectus Excavatum ◽

Statistical Significance ◽

Vertical Position ◽

Haller Index ◽

Correction Surgery ◽

Offset Coefficient ◽

The Right ◽

Biomechanical Factors ◽

The Impact

Background. There is high risk in the correction surgery of pectus excavatum with scoliosis because of the lack of the correction mechanism of pectus excavatum with scoliosis. This study performed a comprehensive analysis about the impact that pectus excavatum had on scoliosis and elaborated its biomechanical mechanism in pectus excavatum patients with scoliosis. Methods. 37 pectus excavatum patients were selected. According to age, Haller index of pectus excavatum, offset coefficient, vertical position, sternal torsion angle, and asymmetric index, 37 patients were, respectively, divided into 2 compared groups. The result was statistically calculated. Results. The scoliosis incidence and severity did not correlate with Haller index, offset coefficient, vertical position, sternal torsion angle, and asymmetric index of pectus excavatum, and there was no statistical significance between the two compared groups. Conclusions. The incidence and severity of scoliosis in PE patients with scoliosis have nothing to do with the geometric parameters of pectus excavatum but correlate with age. The scoliosis will aggravate with the increase of age. The heart may provide an asymmetric horizontal force to push the spines to the right. The mechanism of how the biomechanical factors exert influences on spines needs to be further investigated to keep the spine stable.

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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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Moving Beyond the Haller Index as a Measure of Pectus Excavatum Severity

Biomedical Journal of Scientific & Technical Research ◽

10.26717/bjstr.2017.01.000640 ◽

2018 ◽

Vol 2 (1) ◽

Author(s):

Robert S Eisinger

Keyword(s):

Pectus Excavatum ◽

Haller Index

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Utility of radiation-free imaging for initial evaluation of pectus excavatum

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz145 ◽

2019 ◽

Vol 29 (4) ◽

pp. 503-509 ◽

Cited By ~ 1

Author(s):

Aurélien Scalabre ◽

Floriane Maniouloux ◽

Sophie Vermersch ◽

Arnaud Patoir ◽

Elie Haddad ◽

...

Keyword(s):

Pectus Excavatum ◽

Imaging System ◽

Asymmetry Index ◽

Spearman Correlation ◽

Bonferroni Correction ◽

3 Dimensional ◽

Haller Index ◽

Anthropometric Index ◽

Anthropometric Indexes ◽

Correlation Procedure

Abstract OBJECTIVES The OrtenBodyOne scanner is a radiation-free, 3-dimensional imaging system recently developed for evaluation of the severity of pectus excavatum (PE). The goal of this study was to evaluate the utility of this new imaging system compared with that of computed tomography (CT) for the evaluation of the severity of PE. METHODS Patients treated for PE from April 2015 to January 2017 with available CT and OrtenBodyOne data were included. Correlations between indexes calculated from CT and from OrtenBodyOne were determined by applying the non-parametric Spearman correlation procedure with a Bonferroni correction to adjust for multiple comparisons. RESULTS Forty men (90.9%) and 4 women (9.1%), 20 with symmetrical (45.5%) and 24 with asymmetrical PE (54.5%), were included. The median age was 16.1 years (range 4.3–63.5 years). The following measures and indexes acquired using OrtenBodyOne and CT were significantly correlated: pectus depth (r = 0.84; P = 0.002), anthropometric index (r = 0.81; P = 0.002) and asymmetry index (r = 0.67; P = 0.002). The correlation between the CT Haller index and the external Haller index was only significant for symmetrical PE (r = 0.57; P = 0.008). CONCLUSIONS The OrtenBodyOne imaging system can be used to evaluate the severity of symmetrical PE using the external Haller index. Asymmetry and anthropometric indexes are more reliable for the evaluation of asymmetrical PE. Measures can be repeated throughout treatment while avoiding unnecessary irradiation.

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