scholarly journals Minimal invasive surgical correction of pectus excavatum deformities in adolescents: Our institutional experience

2013 ◽  
Vol 141 (7-8) ◽  
pp. 503-506
Author(s):  
Radoica Jokic ◽  
Dragan Kravarusic ◽  
Milos Pajic ◽  
Jelena Antic ◽  
Zoran Vukasinovic
Keyword(s):  
Pectus Excavatum ◽  
Operative Time ◽  
Postoperative Recovery ◽  
Metal Plate ◽  
Minimal Invasive ◽  
Nuss Procedure ◽  
Chest Deformity ◽  
Institutional Experience ◽  
Pectus Bar ◽  
Invasive Surgical Approach

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.

scholarly journals Sternal elevation techniques during the minimally invasive repair of pectus excavatum

2019 ◽  
Vol 29 (4) ◽  
pp. 497-502 ◽  
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.

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

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.

scholarly journals Intercostal nerve cryoablation versus thoracic epidural for postoperative analgesia following pectus excavatum repair: a systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 486-498
Author(s):  
Jean H T Daemen ◽  
Erik R de Loos ◽  
Yvonne L J Vissers ◽  
Maikel J A M Bakens ◽  
Jos G Maessen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Hospital Stay ◽  
Pectus Excavatum ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Intercostal Nerve ◽  
Nuss Procedure ◽  
Thoracic Epidural

Abstract OBJECTIVES Minimally invasive pectus excavatum repair via the Nuss procedure is associated with significant postoperative pain that is considered as the dominant factor affecting the duration of hospitalization. Postoperative pain after the Nuss procedures is commonly controlled by thoracic epidural analgesia. Recently, intercostal nerve cryoablation has been proposed as an alternative method with long-acting pain control and shortened hospitalization. The subsequent objective was to systematically review the outcomes of intercostal nerve cryoablation in comparison to thoracic epidural after the Nuss procedure. METHODS Six scientific databases were searched. Data concerning the length of hospital stay, operative time and postoperative opioid usage were extracted. If possible, data were submitted to meta-analysis using the mean of differences, random-effects model with inverse variance method and I2 test for heterogeneity. RESULTS Four observational and 1 randomized study were included, enrolling a total of 196 patients. Meta-analyses demonstrated a significantly shortened length of hospital stay [mean difference −2.91 days; 95% confidence interval (CI) −3.68 to −2.15; P < 0.001] and increased operative time (mean difference 40.91 min; 95% CI 14.42–67.40; P < 0.001) for cryoablation. Both analyses demonstrated significant heterogeneity (both I2 = 91%; P < 0.001). Qualitative analysis demonstrated the amount of postoperative opioid usage to be significantly lower for cryoablation in 3 out of 4 reporting studies. CONCLUSIONS Intercostal nerve cryoablation during the Nuss procedure may be an attractive alternative to thoracic epidural analgesia, resulting in shortened hospitalization. However, given the low quality and heterogeneity of studies, more randomized controlled trials are needed.

Deformities of the Thoracic Wall: Don't Forget the Plastic Surgeon

2018 ◽  
Vol 28 (04) ◽  
pp. 361-368 ◽  
Author(s):  
Anton Schwabegger
Keyword(s):  
Pectus Excavatum ◽  
Treatment Options ◽  
Costal Cartilage ◽  
Anterior Wall ◽  
Thoracic Wall ◽  
Reconstructive Procedures ◽  
Chest Deformity ◽  
Aesthetic Results ◽  
Pectus Bar ◽  
Single Method

AbstractSurgical procedures for pectus excavatum (PE) repair, such as minimally invasive repair of pectus excavatum or similar interventions (modified open videoendoscopically assisted repair of pectus excavatum), for remodeling the anterior thoracic wall may finally not always achieve sufficiently pleasing aesthetic results. Particularly in the asymmetric and polymorphic cases, remnant deformities may still be present after any sophisticated remodeling attempt. On the other hand, some cases despite optimal surgical management develop mild recurrences with partial concavity or rib cartilage distortion shortly after pectus-bar removal. Secondary treatment options then may include open access surgery, resection, or reshaping of deformed and prominent costal cartilage. Residual concave areas can be filled by autologous tissue, such as cartilage chips, liposhifting, or implantation of customized alloplastics. To provide the best options for a variety of primary or secondary postsurgical expressions of anterior wall deformities, any physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques or at least should have knowledge of such. However, among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. Careful selection of appropriate techniques, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be mandatory, based on the heterogeneity of symptoms, severity, expectations, and surgical and technical resources. A variety of such ancillary reconstructive procedures for PE repair are explained and illustrated herewith.

Does the modelling of the pectus bar affect its stability? Rationale for using a short flat bar

2019 ◽  
Vol 30 (1) ◽  
pp. 11-17
Author(s):  
David Pérez ◽  
Oscar Martel ◽  
Alejandro Yánez ◽  
José R Cano ◽  
Alberto Cuadrado ◽  
...  
Keyword(s):  
Pectus Excavatum ◽  
Clinical Success ◽  
Nuss Procedure ◽  
Reaction Forces ◽  
Hospital Stays ◽  
Pectus Bar ◽  
Cosmetic Outcomes ◽  
Different Shapes ◽  
Fixation Points ◽  
Alternative Configuration

Abstract OBJECTIVES Although the Nuss procedure for pectus excavatum is still associated with a non-negligible risk of postoperative bar displacement, the potential effects of the length and shape of the bar on its corrective ability and stability have not been sufficiently studied. The aim of this study was to determine how the modelling of the pectus bar affects its stability and whether an alternative configuration of the implant can improve clinical success. METHODS Simulated implantation of bars with different shapes and sizes in a computational model was carried out. A 250 N sternal force was applied to the bars, and the resulting forces and moments on the fixation points were identified. Afterwards, a clinical trial was carried out in a group of patients with pectus excavatum, some of whom received long inverted U-shaped bars and some of whom received implants designed from the computational results. RESULTS When U-shaped bars were tested, the sternal force generated unbalanced horizontal reaction forces (16 vs 61 N) and large reaction moments at the ends of the bar, conferring the tendency to slide and to rotate, respectively. No lateral or rotational destabilizing forces occurred in the case of a flat bar. Cosmetic outcomes, postoperative times and hospital stays were similar in both clinical groups. However, 2 cases (2/15) of bar flipping occurred in patients who received the conventional bar. CONCLUSIONS The shape of the bar is a determinant of its stability. A flat, shorter pectus bar provides adequate correction of the deformity with less tendency for bar displacement in the repair of pectus excavatum.

Influence of Nuss surgical operation for pectus excavatum on electrocardiogram abnormality considering anatomical severity as indicated by Haller index acquired by computed tomography and age

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Funabashi ◽  
Y Kobayashi
Keyword(s):  
Pectus Excavatum ◽  
Minimal Invasive ◽  
P Wave ◽  
Invasive Technique ◽  
Nuss Procedure ◽  
P Waves ◽  
Sinus Arrhythmia ◽  
Haller Index ◽  
Unenhanced Ct ◽  
Before And After

Abstract Background Pectus excavatum (PEX) is a depression of the sternum relative to costal cartilages and sometimes depress heart anatomically which cause abnormal ECG change. Nuss operation is minimal invasive technique for PEX repair. Purpose We speculated this Nuss operation would improve these ECG abnormalities. We also considered the Haller index (HI) and age to these influences. HI is an anatomical severity indicator of PEX calculated from CT. Methods A total of 17 patients (14 male, 12±6 years), who underwent Nuss operation for PEX, underwent unenhanced CT and ECG before and after the Nuss operation. Results All Nuss operation was successfully performed. On CT, HI was significantly improved from 5.62±2.29 to 3.29±0.65 (P=0.0002). A P wave with a negative portion >1 mm deep and >40 ms duration in V1 lead, incomplete right bundle branch block (RBBB), sinus arrhythmia, and right-axis deviation of a QRS wave were diagnosed in 15, 6, 12, and 5 patients, respectively. Comparing before with after Nuss operation, there were no significant differences of the degree of electrical axis of QRS waves, the degree of electrical axis of P waves, or the PQ interval, respectively (All P=NS). Absolute values of voltage of a negative portion of the P wave in V1 lead was significantly improved after the operation (1.55±1.25 vs 0.76±0.91mm, P<0.001). Among 12 patients with sinus arrhythmia, only one patient improved to that without. Among 6 patients with incomplete RBBB, only one patient improved to that without. The correlation coefficient (CC) between “values of the improvement of negative portion of the P wave in V1 lead after the operation” and “HI before operation” was 0.305 (P<0.05). The CC between “absolute values of the improvement of negative portion of the P wave in V1 lead after the operation” and “age at the operation” was −0.216 (P<0.05). Conclusion In patients with PEX, successful Nuss operation could achieve improvement of negative portion of the P wave in V1 lead positively correlated with “HI before operation” and negatively correlated with “age”. Nuss procedure would be more effective to abnormal ECG change, when anatomical severity is severer or age is younger. Improvement of negative P wave Funding Acknowledgement Type of funding source: None

scholarly journals Lung Function after the Minimal Invasive Pectus Excavatum Repair (Nuss Procedure)

2007 ◽  
Vol 31 (7) ◽  
pp. 1518-1522 ◽  
Author(s):  
Daniel C. Aronson ◽  
Remko P. Bosgraaf ◽  
Eva-Maria Merz ◽  
Reindert P. van Steenwijk ◽  
Wim M. C. van Aalderen ◽  
...  
Keyword(s):  
Lung Function ◽  
Pectus Excavatum ◽  
Minimal Invasive ◽  
Nuss Procedure

scholarly journals Usefulness of Infrared Thermal Imaging Camera for Screening of Postoperative Surgical Site Infection after the Nuss Procedure

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Kenya Fujita ◽  
Masahiko Noguchi ◽  
Shunsuke Yuzuriha ◽  
Daisuke Yanagisawa ◽  
Kiyoshi Matsuo
Keyword(s):  
Thermal Imaging ◽  
Pectus Excavatum ◽  
Nuss Procedure ◽  
Infrared Thermal Imaging ◽  
Thermal Imaging Camera ◽  
Imaging Camera ◽  
Pectus Bar ◽  
The Right ◽  
Infection Monitoring ◽  
Ravitch Procedure

Introduction and Objective. The Nuss procedure is widely used in the treatment of pectus excavatum worldwide. Postoperative pectus bar infection is one of the most serious complications associated with this procedure. Therefore, early detection of signs of implant infection is very important. However, this is difficult, and effective methods have yet to be established.Methods. We use a handheld infrared thermal imaging camera to screen patients for postoperative infection following the Nuss procedure. Here, we report a 28-year-old man with recurrent postoperative (Ravitch procedure) pectus excavatum.Results. Infrared thermography camera clearly indicated slight cellulitis in the right chest.Conclusion. Our technique may assist in preventing postoperative bar infection and removal caused by severe bar infection. Furthermore, this camera is potentially suitable for many situations in infection monitoring following subcutaneous implant surgery.

Sign in / Sign up

Export Citation Format

Share Document