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Minimally invasive repair of pectus excavatum


Authors: M. Rygl 1;  M. Vyhnánek 1;  A. Kučera 1;  V. Mixa 2;  V. Věžníková 3;  J. Šnajdauf 1
Authors‘ workplace: Klinika dětské chirurgie UK 2. LF a FN Motol, Subkatedra dětské chirurgie IPVZ, Prahapřednosta prof. MUDr. J. Šnajdauf, DrSc. 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny UK 2. LF a FN Motol, Prahapřednosta prof. MUDr. K. Cvachovec, CSc., MBA 2;  Klinika zobrazovacích metod UK 2. LF a FN Motol, Prahapřednosta doc. MUDr. M. Roček, CSc. 3
Published in: Čes-slov Pediat 2013; 68 (6): 357-363.
Category: Original Papers

Overview

Aim:
Minimally invasive repair of pectus excavatum (MIRPE) has become novel standard procedure for correction of pectus excavatum (PE). This report presents the surgical technique MIRPE and evaluates the results in children and adolescents.

Methods:
Method MIRPE is based on gradual remodeling effect of retrosternal steel bar on chest wall deformity. A convex bar is inserted through small bilateral thoracic incisions under thoracoscopic vision. After 3 years, when permanent remodeling of deformed cartilages has occurred, the bar is removed. The retrospective study of medical reports, imaging and clinical examinations analyzed safety and efficacy of MIRPE in 204 adolescent with PE.

Results:
During the period 2005-2012 the MIRPE was performed on 31 girls and 173 boys, the mean age at the time of surgery was 16.6 y (range 13–28 y). The mean Haller index was 4.7 (range 2.7–20.5). The most common complication was pneumothorax (3.4%), less common problems included atelectasis (1.4%), fluidothorax (0.5%), and lung injury (0.5%). The wound complications were abscess (2.5%), dehiscence (1%), and seroma (0.5%). The incidence of bar displacement was 2%. The most serious complication was cardiac perforation when inserting Lorenz introducer. This occurred in a 16-year-old girl, and she required urgent sternotomy with right atrial repair, she recovered well.

Conclusions:
Pectus excavatum deformity may significantly affect physical and mental quality of life in adolescents and in some cases can be treated surgically. Minimally invasive repair of pectus excavatum (MIRPE) is a safe method with low risk of complications, which reduces the operational stress and has better cosmetic results.

Key words:
pectus excavatum, minimally invasive repair of pectus excavatum, Haller index


Sources

1. Dean C, Etienne D, Hindson D, Matusz P, Tubbs RS, Loukas M. Pectus excavatum (funnel chest): a historical and current prospective. Surg Radiol Anat 2012; 34 (7): 573–579.

2. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg 1949; 129 (4): 429–444.

3. Welch KJ. Satisfactory surgical correction of pectus excavatum deformity in childhood; a limited opportunity. J Thorac Surg 1958; 36 (5): 697–713.

4. Snajdauf J, Sintakova B, Fryc R, et al. Surgical treatment of pectus excavatum and pectus carinatum. Čes--slov Pediat 1993; 48 (10): 581–585.

5. Nuss D, Kelly RE Jr, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (4): 545–552.

6. Lawson ML, Mellins RB, Tabangin M, et al. Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg 2005; 40 (1): 174–180.

7. Fonkalsrud EW. Current management of pectus excavatum. World J Surg 2003; 27 (5): 502–508.

8. Kelly RE Jr, Cash TF, Shamberger RC, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics 2008; 122 (6): 1218–1222.

9. Nuss D. Minimally invasive surgical repair of pectus excavatum. Semin Pediatr Surg 2008; 17 (3): 209–217.

10. Nasr A, Fecteau A, Wales PW. Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta-analysis. J Pediatr Surg 2010; 45 (5): 880–886.

11. Miller KA, Woods RK, Sharp RJ, et al. Minimally invasive repair of pectus excavatum: a single institution‘s experience. Surgery 2001; 130 (4): 652–657; discussion 657–659.

12. Sigalet DL, Montgomery M, Harder J. Cardiopulmonary effects of closed repair of pectus excavatum. J Pediatr Surg 2003; 38 (3): 380–385.

13. Derveaux L, Clarysse I, Ivanoff I, Demedts M. Preoperative and postoperative abnormalities in chest x-ray indices and in lung function in pectus deformities. Chest 1989; 95 (4): 850–856.

14. Morshuis W, Folgering H, Barentsz J, van Lier H, Lacquet L. Pulmonary function before surgery for pectus excavatum and at long-term follow-up. Chest 1994; 105 (6): 1646–1652.

15. Kucera A. Pectus carinatum. Čes-slov Pediat 2005; 60 (12): 672–679.

16. Aronson DC, Bosgraaf RP, Merz EM, van Steenwijk RP, van Aalderen WM, van Baren R. Lung function after the minimal invasive pectus excavatum repair (Nuss procedure). World J Surg 2007; 31 (7): 1518–1522.

17. Castellani C, Windhaber J, Schober PH, Hoellwarth ME. Exercise performance testing in patients with pectus excavatum before and after Nuss procedure. Pediatr Surg Int 2010; 26 (7): 659–663.

18. Hebra A, Swoveland B, Egbert M, et al. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg 2000; 35 (2): 252–257; discussion 257–258.

19. Ohno K, Nakamura T, Azuma T, Yamada H, Hayashi H, Masahata K. Modification of the Nuss procedure for pectus excavatum to prevent cardiac perforation. J Pediatr Surg 2009; 44 (12): 2426–2430.

20. Takagi S, Oyama T, Tomokazu N, Kinoshita K, Makino T, Ohjimi H. A new sternum elevator reduces severe complications during minimally invasive repair of the pectus excavatum. Pediatr Surg Int 2012; 28 (6): 623–626.

21. Tedde ML, de Campos JR, Wihlm JM, Jatene FB. The Nuss procedure made safer: an effective and simple sternal elevation manoeuvre. Eur J Cardiothorac Surg 2012; 42 (5): 890–891.

22. Moss RL, Albanese CT, Reynolds M. Major complications after minimally invasive repair of pectus excavatum: case reports. J Pediatr Surg 2001; 36 (1): 155–158.

23. Bouchard S, Hong AR, Gilchrist BF, Kuenzler KA. Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum. Semin Pediatr Surg 2009; 18 (2): 66–72.

24. Gips H, Zaitsev K, Hiss J. Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature. Pediatr Surg Int 2008; 24 (5): 617–620.

Labels
Neonatology Paediatrics General practitioner for children and adolescents
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