Minimally Invasive Repair for Treating Pectus Excavatum — Early Results

Abstract

Results: operative mortality was zero and there were no clinically significant bleeding complications. epidural analgesia was necessary for adequate pain control. small symp tomless residual pneumothoraxes and pleural effusions were common after the operation but neither required intervention. one patient had ah emothorax 7m onths postopera tively,which was cured with asingle puncture. bar displacement took place in 2patients but required correction in only one of these patients. there were 2wound infections, one superficial and one which led to removal of the bar was 6m onths after the operation. this may have been unnecessary.t wo patients had pneumonia, one probably unrelated to the operation. one patient required psychiatric ward treatment, and 3p atients had mild psychological symptoms not requiring specific therapy.t he preliminary cosmetic results were good or excellent in 90% of the cases, but alonger followup is needed for information on the final outcome.Conclusions: Mirpe is as afe operation and gives ac osmetically good result. thora coscopy is needed during the operation. the early postoperative period in hospital is painful and there the patients need intensive care. We found the high epidural analgesia beneficial and safe during early period of pain treatment. the bar is removed not earlier than 3years after the operation as aday care surgical procedure.

Minimally invasive repair of pectus excavatum deformity

“…Thirty-two [4,38] publications with 2997 patients (median: 53; range: 10-947) reported results following MIRPE with the metallic bars in situ (Table 1). Twenty-three publications [4,6,11,[13][14][15][16][17]21,[23][24][25][26][27][30][31][32][33][34][35][36][37][38] with 1393 (median: 36; range: 6-521) patients reported results after MIRPE completion with the bar(s) having been removed (Table 2). One study reported the results of MIRPE in 50 patients in whom a previous, conventional repair of PE had failed (redo surgery) [27].…”

“…Eighteen studies [6,7,11,13,15,[20][21][22][23]25,27,29,31,32,34,36,39,41] (Table 1) report from a mixed population from all three age groups. Five publications [4,[8][9][10]18] report from a mixed paediatric and adolescent population.…”

“…Five studies reported an overall improvement (35-100%) in the 'general health' of the operated individuals. Two studies used the SSQ [12,24] on a population of adolescents and adults; one used the PEEQ [9] on a mixed population of paediatrics, adolescents and adults; one study used a combination of the CHQ-CF87 and the PEEQ [28] on a population of adolescent patients; the fifth study reported subjective data, for example, 'feeling better' post-MIRPE [31]. The variability in the improvement of 'general health' (35-100%) and the fact that most studies had included patients who underwent surgery for cosmetic reasons, highlights the fact that despite their young age, a large number of patients had very good 'general health,' which would be difficult to further improve.…”

“…A number of authors [2][3][4]7,10,11,[13][14][15]17,19,21,22,25,26,[28][29][30][31][34][35][36][37][38][39][40] have measured Haller's index or pectus severity index (PSI) as part of their preoperative assessment. Although a PSI of >3.2 was used as an inclusion criterion for MIRPE in some reports, in some of these, the authors admitted that they had performed MIRPE upon patients with a PSI of <3.2 [4,11,13,14,17,25,28,30,36,38,27,39].…”

Minimal Invaziv Pektus Ekskavatum Duzeltme Ameliyati: Teknik Ve Uygulama, Marmara Deneyimi

“…Bu olgularda retrosternal yapışıklıklar konusunda dikkatli olunmalı, torakoskopun gözetiminde tünel oluşturulurken titiz çalışılmalı, gereken olgularda toraks dreni yerleştir-mekten kaçınılmamalıdır (10,19,33,34).…”