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At least 919 records · Page 51Linked to original sources
PubMed2006

Open repair of pectus excavatum and carinatum deformities with minimal cartilage resection.

BACKGROUND: Numerous modifications of the Ravitch open repair of pectus excavatum (PE) and carinatum (PC) have been used by surgeons with inconsistent results. METHODS: During a 3-year period, 275 consecutive patients underwent open repair of PE and PC using a new less invasive technique. A small chip of costal cartilage was resected medially and laterally from each deformed cartilage, allowing it to barely touch the sternum and rib (laterally) after the sternum had been elevated or depressed, and twisted to the desired position. A support strut used for all patients was routinely removed within 6 months. RESULTS: With mean follow-up of 17 months, all but 5 patients regarded the results as very good or excellent. There were no major complications or deaths. CONCLUSION: Open repair using minimal cartilage resection is effective for all variations of PE and PC in patients of all ages, causes only mild pain, and produces good physiologic and cosmetic results.

Adolescent↗
PubMed2004

Repair of the pectus deformity: results of the Ravitch approach in the current era.

BACKGROUND: Recent publications have advocated a minimally invasive approach to repair of the pectus deformity. Efforts to evaluate this new approach have been hampered by lack of comparative information regarding outcomes of the standard Ravitch approach. We use a modified Ravitch procedure, and present our series as a basis for comparison. METHODS: Records of 69 consecutive patients undergoing repair of the pectus deformity were retrospectively reviewed. Modifications included a minimal incision and a new technique to address sternal angulation. A patient satisfaction survey evaluated the patients' perception of the outcome. RESULTS: We found one wound infection (1.4%). Five patients (7.2%) had a seroma, and were treated as outpatients. Because the minimally invasive approach is used for pectus excavatum, we divided our series into excavatum and carinatum subsets. The subset of 44 pectus excavatum patients had a mean postoperative length of stay (LOS) of 2.9 days. The median patient satisfaction score was 4 on a scale of 1 to 5, at an average of 4.75 years after repair. The subset of 25 pectus carinatum patients had a mean LOS of 2.4 days and a median patient satisfaction score of 5. CONCLUSIONS: The modified Ravitch procedure yields excellent results with low morbidity, hospital LOS, and cost, combined with high patient satisfaction. These current data will be useful for comparison as newer techniques for pectus repair continue to evolve.

Adolescent↗
PubMed2006

A life-threatening complication of the Nuss procedure for pectus excavatum.

We describe a delayed, life-threatening complication in a boy operated on using the Nuss-procedure 2 months earlier. On admittance he was in shock with cardiac tamponade. An immediate needle aspiration of blood from the pericardium was done before a median sternotomy. The Nuss-bar was removed, and we identified a 1.5-cm laceration in the adventitial layer of the ascending aorta as the source of bleeding. The tear was closed, and the patient had an uneventful recovery. Careful positioning of the bar is necessary to avoid complications. Measures must be taken postoperatively to confirm that the steel bar does not rotate.

Abdominal Pain↗
PubMed2005

Analysis of the Nuss procedure for pectus excavatum in different age groups.

BACKGROUND: The Nuss procedure is a newly developed operative method for minimally invasive repair of pectus excavatum in pediatric patients. However, the surgical indication for this procedure has been extended into adult patients. The aim of this study was to assess the surgical outcome of the Nuss procedure in different age groups and to analyze its feasibility in the adult population. METHODS: From December 1999 to March 2003, 51 patients (40 males and 11 females) with pectus excavatum underwent the Nuss procedure. We classified patients into three groups based on age (pediatric, adolescent, and adult), retrospectively analyzed demographic, intraoperative and postoperative data, and compared outcomes among each group. RESULTS: Mean operation time was 52.0 +/- 22.9 minutes, 80.4 +/- 27.4 minutes, and 127.3 +/- 44.9 minutes in the pediatric, adolescent, and adult groups, respectively (p < 0.001). Postoperative complications occurred in 3 of 27 patients (11.1%) in the pediatric group and in 7 of 12 patients (58.3%) in both the adolescent and adult groups (p = 0.002). Reoperations were performed due to complications in 1 of 27 patients (3.7%) in the pediatric group, 2 of 12 patients (16.6%) in the adolescent group, and 5 of 12 patients (41.7%) in the adult group (p = 0.001). CONCLUSIONS: The Nuss procedure is highly recommended in pediatric patients with pectus excavatum. However, in adults it is necessary to select patients carefully because of the longer operation time and higher incidence of complications associated with the procedure in this population.

Adolescent↗
PubMed2006

New endoscopic minimal access pectus carinatum repair using subpectoral carbon dioxide.

PURPOSE: This study establishes a minimal access hybrid technique for pectus carinatum repair. Based on 132 conventional repairs (1984-2000) and our own endoscopic technique for correcting prominent costal arches, the conventional carinatum repair was adapted to an endoscopic-assisted technique. DESCRIPTION: Inserting two submuscular trocars and inflating CO2, the entire ventral thoracic wall was dissected endoscopically detaching pectoral muscles from ribs and sternum. February 2001 to February 2004, we repaired 37 patients (32 male) of 16.8 +/- 4.3 years (12 to 36 years). Endoscopic-assisted rib resection and axial reanastomosis, transsternal struts, and sternotomies were performed semi-open from a 2.9 to 4.7 cm incision. EVALUATION: All were completed minimally invasively, one seroma was managed conservatively. Thirty-three patients rated their result as excellent, 4 as good with a follow-up of 29.1 +/- 9.5 months (range, 18 to 55 months). Twenty-one struts were removed with no recurrence. CONCLUSIONS: Minimal access pectus carinatum repair is safe, effective, and offers high comfort for the patient. The results are at least as good as conventional repairs, but hospital stays could be halved. Encouraging results of this early experience warrant further evaluation by other centers.

Adolescent↗
PubMed2006

Nonprosthetic surgical repair of pectus excavatum.

BACKGROUND: Previously, a method was reported to correct pectus excavatum in which a convex steel bar is inserted beneath the sternum. This method gained popularity, but a relatively high incidence of complications has been reported. We review our experience of nonprosthetic repairs of pectus excavatum. METHODS: From 1993 through 2004, 62 patients underwent repair of pectus excavatum. Sternocostal elevation was adopted for 54 patients (11.7 +/- 8.3 years old). A part of the third or fourth to the seventh costal cartilages was resected. All of the stumps were pulled to generate tension and resutured with the sternum. Cortical osteotomy of upper sternum and introduction of exogenous material were not employed. Sternal turnover and overlap was adopted for 8 adults (24.1 +/- 9.0 years old) with severe asymmetric deformities. The sternum was cut at the level of the second or third intercostal space. The lower part of the sternum was turned over and secured in a position so that it overlapped with the upper sternum, and the stumps of cartilages were reattached to the plastron. In these procedures, the natural tension exerted by the patient's ribs is sufficient to elevate and fix the sternum. RESULTS: Mechanical ventilation was not required after emergence from anesthesia. None of the patients experienced threatening complications or required reoperation. Fifty patients (81%) were graded as excellent, and 12 patients (19%) were graded as good at 1 month after surgery. CONCLUSIONS: The procedures described here yielded excellent results with low morbidity and no mortality, and produced high patient satisfaction.

Adolescent↗
PubMed2005

Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity.

OBJECTIVE: The Nuss procedure is a minimally invasive pectus repair. This study represents an attempt towards exploring the changes in quality of life and overall satisfaction in young male adults who underwent a Nuss procedure. METHODS: We have included 20 male patients with a median age of 18 years (range: 14-37 years). We have used two specific questionnaires: the two-step Nuss evaluation Questionnaire modified for Adults (NQ-mA) and a new Single Step Questionnaire (SSQ). The data was analysed using Wilcoxon signed rank test to determine statistical significance of differences, with a <0.05 level of significance. Spearman's correlation coefficient was used to assess the correlation between the answers. RESULTS: The primary indication for surgery was cosmetic. Both questionnaires were adequate to measure disease-specific quality-of-life changes after surgery and were able to confirm the positive impact of surgery on both the physical and the physiological well-being of young adults. Statistical analysis of the scoring of the individual questions and the total score of individual patients revealed a statistically significant improvement (p<0.05) following surgery. The SSQ had a highly significant correlation to the NQ-mA questionnaire (correlation coefficient=0.682, p=0.001). Overall, the SSQ revealed a statistically significant improvement (p=0.001) in self-esteem and a high level of satisfaction following the Nuss procedure. Only two patients fell into a low satisfaction group. CONCLUSION: The Nuss procedure has already been shown to have a positive impact on both the physical and psychosocial well-being of children who are suffering from pectus excavatum deformity. We have shown a similar positive impact in young male adults, in the short term.

Adolescent↗
PubMed2006

Heart failure following left-sided pneumonectomy in a patient with known pectus excavatum -- successful treatment using the Ravitch procedure.

A rare case of a patient with progressive dyspnoea due to atrial compression between ascending and descending aorta is demonstrated. After neoadjuvant chemoradiation for a locally advanced nonsmall cell lung cancer stage IIIb, he had a left-sided pneumonectomy. The underlying problem for cardiac compression was the extreme mediastinal shift reinforced by a congenital pectus excavatum. Our treatment was a Ravitch procedure with fair result.

Carcinoma, Non-Small-Cell Lung↗
PubMed2006

Pulmonary function following surgical repair of pectus excavatum: a meta-analysis.

The purpose of this study was to use a meta-analytical technique to examine the efficacy of surgical repair of pectus excavatum on pulmonary function. Studies were retrieved via computerized literature searches, cross-referencing from original and review articles. Inclusion criteria were as follows: (1) reporting quantitative measures of preoperative and postoperative pulmonary function; (2) published in the English language; (3) indexed between January 1960 and September 2005; (4) reporting the duration between which preoperative and postoperative assessments were conducted; and (5) describing the pulmonary assessment procedures. The titles and abstracts of potentially relevant articles were reviewed to determine whether they met the criteria for inclusion. Twelve studies representing 313 pectus excavatum patients met the inclusion criteria and were used for the meta-analysis. Random-effects modeling yielded a mean weighted effect size (ES) for pulmonary function which was statistically nonsignificant (ES=0.08, 95% CI=-0.20 to 0.35; P=0.58). The findings of the present study indicated that surgical repair of pectus excavatum does not significantly improve pulmonary function. These findings, however, may be a result of testing pulmonary function under conditions in which pectus excavatum does not manifest itself.

Exercise Tolerance↗
PubMed2004

Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications.

PURPOSE: Because the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. The authors examined complications in a single-institute experience of the Nuss technique to develop possible solutions to prevent them. METHODS: A total of 335 consecutive patients who underwent the Nuss procedure between August 1999 and September 2002 were studied retrospectively. Median age was 8 years (range, 1 to 46). Two hundred sixty-four patients (78.8%) were in the pediatric group (age < or = 15) and 71 patients (21.2%) were in adult group (age > 15). One hundred ninety-three patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multivariate logistic regression. RESULTS: Postoperative complication rate was 16.1% (54 of 335) in total patients. Early complications (within a month) were pneumothorax (n = 23; 6.9%), wound seroma (n = 11; 3.3%), and bar displacement (n = 8; 2.4%). Late complications (after a month) were pericarditis and pericardial effusion (n = 5; 1.5%), bar displacement (n = 4; 1.2%), and hemothorax (n = 3; 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease of complication rate in later experience (operation date 1, 29.4%; 15 of 51 v. operation date 2, 12.0%; 34 of 284; P =.004). Grand Canyon type (eccentric long canal type) showed a higher complication rate than other types (40%, 12 of 30 v. 12.1%, 37 of 305; P <.001). Risk factors were analyzed in each group. CONCLUSIONS: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (earlier date of operation). Complication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with the current technique.

Adolescent↗
PubMed2004

Postpericardiotomy syndrome after minimally invasive repair of pectus excavatum.

Minimally invasive repair of pectus excavatum (MIRPE) was first reported in 1998 and has gained wide acceptance since then. A 17-year-old girl who had undergone thoracotomy and cardiac surgery for transposition of great vessels at the age of 18 months presented with a deep, long pectus excavatum with asymmetry. After initial uneventful postoperative clinical course after MIRPE, the patient had bilateral pleural and pericardial effusion on the sixth postoperative day. Suspecting postpericardiotomy syndrome, systemic steroids were administered, and the symptoms resolved without affecting wound healing. Manifestation of a pericardial effusion combined with bilateral pleural effusion after MIRPE, especially in patients after cardiac surgery, may indicate a postpericardiotomy syndrome that can be treated successfully by intravenous steroids.

Adolescent↗
PubMed2005

Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure.

BACKGROUND/PURPOSE: Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs) in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal. METHODS: The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson's equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100% of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expiratory flow (FEF25%-75%). RESULTS: Preoperatively, FVC and FEV1 medians were lower than the normal by 13%, whereas the FEF 25-75 median was lower than normal by 20% (all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean post-bar removal improvement than the younger patients. An older patient with a preoperative FEF25-75 score of 80% of normal would be predicted by these data to have a postoperative FEF25-75 of 97%, indicating almost complete normalization for this function. CONCLUSIONS: These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.

Adolescent↗
PubMed2005

Should an infected Nuss bar be removed?

BACKGROUND: The Nuss procedure is a minimally invasive procedure for correction of pectus excavatum. It involves insertion of a substernal metal bar. A feared complication of any implanted device is infection, which often necessitates removal. The purpose of this report is to describe the authors' experience with infectious complications after the Nuss procedure. METHODS: From February 2000 to July 2002, 102 patients underwent the Nuss procedure in 2 pediatric surgical centers. In a retrospective way, the files of those patients in whom a postoperative infection developed were studied. RESULTS: Seven patients suffered postoperative infectious complications. Only one bar needed to be removed. CONCLUSION: The authors' experience indicates that there is no need for immediate removal of an infected Nuss bar. Most of these infections can be managed conservatively. However, early antibiotic treatment is warranted to ensure salvage of the bar.

Adolescent↗
PubMed2005

A new technique for removing the pectus bar used in the Nuss procedure.

BACKGROUND/PURPOSE: The Nuss procedure involves elevation of the sternum using a pectus bar, which is subsequently removed after approximately 3 years. When removing the bar, the tip of 1 end of the bar is exposed, and then the body is changed to the lateral recumbent position to remove the bar along the body surface. However, changing body positions in a sterile manner is often difficult. In this report, the authors present a new technique using their original bender design with which pectus bars can be smoothly removed. METHODS: After exposing the pectus bar by placing a skin incision in the same location as had been used for bar insertion, benders were inserted subcutaneously into the thoracic wall at both ends of the bar. The bar was then immobilized, straightened, and removed. No change of body position was required. CONCLUSIONS: Between 2002 and 2003, this technique was used on 10 patients, and the bars were removed easily from all patients. The new procedure uses benders at both ends of the pectus bar as supporting points. This reduces the force required to straighten the bar and stabilizes the bar during removal. Most importantly, our procedure eliminates the need for change of body position.

Funnel Chest↗