Technical Modification of the Nuss Operation for the Correction of Pectus Excavatum

Campos, José Ribas Milanez de; Fonseca, Marcelo Heleno; Werebe, Eduardo de Campos; Velhote, Manuel Carlos Prieto; Jatene, Fábio Biscegli

doi:10.1590/s1807-59322006000200018

Cited by 13 publications

(4 citation statements)

References 3 publications

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“…Relevant psychological alterations have been described, among which are anxiety, difficulty in participating in social relationships, limited working capacity, reduction in tolerance to frustration, and depression. 4 The treatment of PEX accepted by most authors is surgical treatment, 5,6 and indication for treatment is based on functional findings, 3 psychological findings, 4 the patient's quality of life findings, 7 and aesthetic reasons. 8 Few studies have objectively classified the degree of anatomic distortion to enable the quantification of the depression of the anterior thoracic wall, the comparison of groups, and the assessment of postoperative results.…”

Section: Introductionmentioning

confidence: 99%

Anthropometric Index for Pectus Excavatum

Rebeis

Campos

Fernandez

et al. 2007

Clinics

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BACKGROUND: Pectus excavatum (PEX) is a depression of the sternum in relation to the costal cartilages. Clinical and objective measures for classifying the defect are rare and difficult to apply. The present study aimed to create an anthropometric index (AI) for PEX as a method for diagnosis and for preoperative and postoperative assessment by comparing it to the Haller index (HI) and to the lower vertebral index (LVI). METHODS: From December 2001 to February 2004, 2 groups of patients were studied at our institution: a) 30 patients with normal configuration of the thoracic cage, upon physical examination; b) 20 patients with PEX. The latter underwent surgery according to the Ravitch technique modified by Robicsek, and they were evaluated in the postoperative period. All patients were assessed by means of the AI (clinical), HI (tomographic), and LVI (radiographic) measures at the level of deepest deformity in the case of the PEX patients, and in the distal third of the sternum in the normal patients. The patients who had undergone surgery were once again measured between the 60th and the 80th postoperative days. RESULTS: There was a high correlation between the AI and the HI (80% P < .001) and between the AI and the LVI (79% P < .001). The accuracy of the 3 indices was similar, in that the following cut points were established: AI = 0.12, HI = 3.10, and LVI = 0.25. Upon analyzing the preoperative results, we verified that for the 3 indices, over 75% of the patients with pectus excavatum were above the cut points and were confirmed as having the defect. In the postoperative results, the value of the indices found below the cut point was considered within the normal standard, and this occurred in 100% for the AI, in over 50% for the HI, and in 50% for the LVI. CONCLUSIONS: The AI allowed adequate measurement of the defect, maintaining a) a high correlation with the HI and the LVI and a high accuracy, similar to the already acknowledged and published indices and b) an efficient comparison between the preoperative measurement and the postoperative results.

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Section: Introductionmentioning

confidence: 99%

Anthropometric Index for Pectus Excavatum

Rebeis

Campos

Fernandez

et al. 2007

Clinics

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“…Depending on the case, they can be inserted through the main incision or above the incision. 8,[15][16][17][18] However, there have been reports of injury to the liver and diaphragm, such as liver perforation, with this method. 3 When a trocar is inserted through the main incision with the introducer, 16 the main incision is inevitably enlarged, making it longer than 1 cm.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of a trans-illuminated introducer during the Nuss procedure

Song

Lee

2018

Asian Cardiovasc Thorac Ann

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Background There has been an increase in the number of patients undergoing the Nuss procedure for cosmetic purposes, thus increasing the need for safer surgery. However, there are reports of massive hemorrhage and organ damage during the Nuss procedure which involves dissection of the anterior mediastinum. We have developed the trans-illuminated introducer that allows safe surgery while maintaining a small surgical incision of less than 1 cm. Methods This study was a retrospective review of 306 patients aged 3-40 years who underwent the Nuss procedure using the trans-illuminated introducer at our hospital between April 2006 and December 2014. Results There were 29 (9.5%) early postoperative complications. The most common early complication was pneumothorax (15 cases, 4.9%). Five (1.6%) patients developed hemothorax in the early postoperative period, which occurred independently of the dissection process of the anterior mediastinum. None of these patients required reoperation or blood transfusion. There were no complications caused by the introducer during dissection of the anterior mediastinum. Conclusions Using the trans-illuminated introducer, we were able to dissect the anterior mediastinum without a major complication, such as massive hemorrhage from the mediastinum, while maintaining a small surgical incision for cosmetic purposes. Therefore, we consider that the trans-illuminated introducer is useful for improving the outcome of the Nuss procedure.

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“…Among those alterations are some that were specifically conceived to prevent problems at the riskiest stage of the procedure, which is the creation of the retrosternal tunnel. Our group has contributed to some of those modifications (3,4), and has added steps to comprise what is our current MIRPE technique for difficult cases.…”

Section: Methodsmentioning

confidence: 99%

Management of deep pectus excavatum (DPE)

Campos

Tedde

2016

Ann. Cardiothorac. Surg.

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The correction of deep pectus excavatum, with the Nuss procedure, frequently require a series of maneuvers that is inherently dangerous. Herein we describe 10 technical modifications to prevent potential complications.These modified techniques have certain advantages and according to the authors, with these maneuvers the risk of pericardial sac, cardiac injury, bar displacement and complications during the removal of the bar could be markedly reduced.

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Technical Modification of the Nuss Operation for the Correction of Pectus Excavatum

Cited by 13 publications

References 3 publications

Anthropometric Index for Pectus Excavatum

Anthropometric Index for Pectus Excavatum

The usefulness of a trans-illuminated introducer during the Nuss procedure

Management of deep pectus excavatum (DPE)

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