Background: Abramson technique is a worldwide technique used for minimally invasive treatment of pectus carinatum. We have performed this surgery since 2012. This article presents our experience about Abramson surgery. Materials and Methods: Between June 2012 and December 2019 64 patients with pectus carinatum underwent minimally invasive surgery. Results: Mean age of the patients were 14.4 years (range 8-25 years). 47 were male, 17 were female. All patients referred to our clinic with cosmetic complaints. 14 (21.8%) patients also had clinical symptoms in preoperative period. Mean duration of operation was 61 minutes. Mean blood loss was 30 ml and death wasn't seen in any patient. Complication was seen in 15 (10.7%) patients in postoperative period. Splitting of cables was seen in 7 (10.9%) patients as the most common complication in the long term follow-up. Duration of hospitalization ranged from 3 to 15 days (average 5.1 ± 2.9 days). Reoperation was performed in 17 (26.5%) patients. Conclusions: Minimally invasive surgery is successful for the treatment of pectus carinatum.
Background: Pectus carinatum (PC) presents with anterior protrusion of the chest wall in the childhood period and becomes more prominent during puberty. Optimum time for surgery concerns the life period with flexibility of the chest wall. However, today Abramson operation is performed for younger and adult patients by many surgeons. In this study, we aimed to compare the complication results of Abramson surgery for PC between pediatric, adolescent and adult groups, to indicate the optimal appropriate period for this surgery. Materials and Methods: From 2012 to 2018, 178 cases had symmetric-asymmetric PC identified. A total of 63 patients who could not use or had unsuccessful outcomes with a brace therapy were treated with Abramson surgery in our clinic. We classified patients into three groups: Pediatric (patients younger than 12 years), adolescent (patients between 13 and 16 years); and adult (patients between 17 and 20 years). We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates. Results: Fifty patients were male and 13 were female. The age range was 8 to 20 years (mean 14.5±2.5 years). Symptomatic patients and chest pain in the preoperative period were seen more frequently in patients with older age, but this was not statistically significant (p:0.061, p:0.901, p:510). There was no significant difference between groups with respect to duration of operation, and duration of follow up (p:0.338, p:0.646, p:0.668). In the early 30-day postoperative period, no mortality was observed. In logistic regression analysis, postoperative complications increased in patients older than 17 years, but this wasn't statistically significant (p:0.256). Conclusions:The Abramson procedure is an effective and successful method with low complication rates in the group who do not benefit from a brace for treatment of pectus carinatum. However, complication rates may increase in the adult period, though this was not statistically significant.
Objective: Difficulties with sternal bone healing or infection after a median sternotomy performed for open cardiac surgery can result in significant morbidity and mortality. This study evaluates the efficacy, safety, advantages, disadvantages, and techniques related to the use of thermoreactive nitinol clips (TRNCs) to treat sternal dehiscence.Methods: TRNCs were used to close the sternum in 40 patients (26 male, 14 female; mean age: 60±4 years, range: 45-76 years) with sternal dehiscence that developed following primary cardiac surgery between July 2010 and February 2019. Sternum revision was performed at a mean of 72±4 days postoperative (range: 9-255 days). Vacuum-assisted closure (VAC) was applied before the surgical intervention in 55% (n=22) of the patients due to superficial wound infection.Results: Pleurisy was observed in 1 patient, and pneumonia developed in 1 patient after the revision. Mortality did not occur during hospitalization. The nitinol plates were removed in a second revision surgery in 9 patients: a pectoralis flap was created for 3, a reconstructive rectus flap was used in 1, and primary wound closure was implemented in 5 cases due to recurrent wound infection. Mortality was recorded in 1 patient in the postoperative period. Sternotomy complications of recurrent sternal dehiscence, mediastinitis, sternal abscess, or secondary osteomyelitis were not observed in 6 months of follow-up. Conclusion:Surgical interventions for sternal dehiscence should optimally be performed in the early period to decrease the risk of dehiscence secondary to infection and mediastinitis. The use of TRNCs for patients with sternal dehiscence was successful and decreased the duration of hospital stay and the risk of postoperative complications, as well as providing greater patient comfort.
Aim: In 1998, Donald Nuss suggested the insertion of a metal bar behind the sternum for pectus excavatum as a minimally invasive technique. However, data regarding the relation between the age of the patient and clinical results of repair is limited. Aim of this study is to compare the clinical results of Nuss surgery for pectus excavatum in different age groups, to point out the optimal range of age for this procedure. Material and Methods:From February 2012 to January 2020, data regarding 140 patients have been treated with Nuss surgery. We classified patients into three groups: patients younger than 15 years (group A), patients between 15 and 20 years (group B); and patients older than 20 years up to 40 years (group C) retrospectively. We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates.Results: One hundred ten patients were male and 30 were female. Male patients, clinical symptomatic patients with dyspnea in the preoperative period were seen more frequently in patients with older age, and each were statistically significant (p:0.003). In the early 30-day postoperative period, no mortality was observed. The most frequent postoperative complications were observed in group C (40,9%), followed by group B (18,2%) and group A (9,6%)(p:0.007). In logistic regression analysis, postoperative complications increased significantly in patients older than 20 years (p:0.003). Brace therapy was performed for 2 cases in Group A for recurrence after bar removal which occurred in adolescant period. Conclusion:Nuss procedure can be recommended with low complication rates, short term hospitalization and high grade of success. Although the childhood period seems to be more suitable regarding the complications, surgery can be preferred with low recurrence rates in adolescant period.
Background: We reviewed pre-, intra-, and post-operative clinical data, including morbidity and mortality rates, for patients who underwent Nuss surgery to repair pectus excavatum. Materials and Methods:Nuss procedure was performed in 140 patients at our clinic between 2012 and 2019 (males: 108; females: 32 females; mean age: 15.7 ± 7.8 years; range: 3-40 years). The Haller index was mild (2.5-3.2) in 72, moderate (3.2-3.5) in 40, and severe (3.6-6.0) in 28 patients.Results: None of the patients died. Morbidity or bad blood loss was not observed. The mean duration of surgery was 59.5 ± 21 min (range: 30-120 min). The mean duration of postoperative hospitalization was 4.6 ± 2.9 days (range: 3-19 days). The procedure was performed using one (n = 107; 76.4%), two (n = 31; 22.2%), or three (n = 2; 1.4%) bars. There were five cases of early pneumothorax, four pleural effusions, five bar displacements, two wound infections, one hematoma, seven bar exposures due to allergies, and three costal fractures. Conclusions:The Nuss operation is an effective, minimally-invasive treatment for pectus excavatum. It has the advantages of a short duration of surgery and low morbidity and mortality rates. Therefore, the Nuss operation may be considered the treatment of choice in cases of pectus excavatum.
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