Nuss procedure for combined pectus excavatum and carinatum in a patient with a history of congenital esophageal atresia repair surgery

Cardiothoracic surgery usually causes tissue adhesion on the operation site which increases the risk of complications in the subsequent thoracic surgery including Nuss procedure. Disorders that require cardiothoracic surgery include chest wall deformities such as pectus excavatum, congenital heart diseases, lung diseases such as congenital cystic adenomatiod malformation and bronchopulmonary dysplasia, and congenital diaphragmatic hernia. Recently, we encountered a rare case of combined pectus excavatum and carinatum in a patient with a history of congenital esophageal atresia repair surgery. Commendably, despite tissue adhesion from the previous surgery, a modified Nuss procedure was performed successfully with no complications. We agree that the Nuss procedure is feasible for thoracic deformities in patients with a surgical history of cardiothoracic surgery.

Brustwanddeformitäten bei Kindern und Jugendlichen

ZusammenfassungBrustwanddeformitäten im Kindes- und Jugendalter sind als Ganzes betrachtet relativ häufig, wobei sie ein weites Spektrum von zum Teil sehr seltenen Entitäten umfassen. Pectus excavatum hat die höchste Prävalenz, es können symptomatische und asymptomatische Fälle auftreten. Symptomatische Patienten sollten behandelt werden, wobei die minimalinvasive operative Korrektur als effektiveres Verfahren neben der Saugglockenbehandlung die größte Rolle spielt. Pectus carinatum und Mischformen der Brustwanddeformität können ebenfalls zu einem erheblichen Leidensdruck führen und bedürfen in solchen Fällen einer individualisierten Therapie. Syndromale Brustwanddeformitäten wie beispielsweise das Jeune-Syndrom bilden eine eigene Gruppe von sehr seltenen Erkrankungen, die erhebliche, zum Teil auch lebensbedrohliche Komorbiditäten aufweisen. Solche Patienten sollten in Zentren mit entsprechender Expertise interdisziplinär und multimodal behandelt werden. Diese Übersichtsarbeit stellt die einzelnen Brustwanderkrankungen, deren Bedeutung und mögliche Therapieansätze vor.

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups. Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.