Minimally Invasive Repair of Pectus Excavatum

Hebra, André

doi:10.1053/j.semtcvs.2009.04.005

Cited by 44 publications

(24 citation statements)

References 35 publications

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“…However, a number of the articles in this review [4,11,13,14,17,25,28,30,36,38,27,39] included patients for MIRPE with a PSI <3.2 or included no assessment of PSI [5,6,8,9,12,16,18,20,23,24,32,33]. This may reflect the fact that eccentric or barrel-chest deformations can lead to a 'false PSI calculation' of less than 3.2.…”

Section: Discussionmentioning

confidence: 99%

“…Such a 'minimally invasive' approach has proven to be extremely popular amongst patients and thoracic surgeons, despite limited reports on outcomes. Given that the primary motive for most patients seeking surgical correction is concern for their physical appearance and its social acceptability, it is not surprising that smaller scars located away from the most visible areas of the chest wall are most preferred [5]. A large number of institutions have reported their results with MIRPE, but few have reported outcomes that are relevant to the concerns, which led the patient to undergo such surgery, and even fewer give long-term results following bar removal.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive repair of pectus excavatum deformity

Krasopoulos

Goldstraw

2011

European Journal of Cardio-Thoracic Surgery

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This review is trying to address the effectiveness and sustainability of results following minimally invasive repair of pectus excavatum (MIRPE). The aim is to present these results for the benefit of clinicians and the patients. Literature search has revealed 179 hits, which were independently assessed and led to 80 publications being formally reviewed. Studies reporting results from less than 10 patients were excluded. Thirty-five studies were found to be reporting results from patients' and/or surgeons' perspective and they were included in this review. Data from the United Kingdom registry for MIRPE were also included. Results from over 2997 patients (age: <1-85 years) who had MIRPE and 1393 patients who had their metallic bar removed were assessed. The most common indication for surgery was cosmesis. There was a net gain with regard to self-esteem for 96-100% of the individuals. A percentage of procedures (0-20%) was assessed by surgeons as having an 'unsatisfactory outcome' and a number of patients (0-25%) reported an 'unsatisfactory end result.' However, these percentages are not necessarily referring to the same patients and an unsatisfactory result does not seem to affect the positive effect on self-esteem. The reported changes in social life, lung capacity, cardiovascular capacity, exercise capacity and general health are based on weak data and significant improvements, if any, are probably seen in a limited number of patients. The metallic bars were removed after 1.5-4.5 years and there is an overall 0-4.5% reported recurrence post-bar removal. In conclusion, MIRPE may improve cosmesis and self-esteem of patients with pectus excavatum deformity. Direct or indirect improvement in other physiological parameters may also help the 'well-being' of these patients and their social integration. There is a clear need for standardisation in the way results are reported in the literature and a socioeconomic analysis with regard to gains, benefits and costs related to MIRPE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally invasive repair of pectus excavatum deformity

Krasopoulos

Goldstraw

2011

European Journal of Cardio-Thoracic Surgery

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“…It is generally believed that Nuss procedure is not suitable for children of low age. The main reason is worrying about the high recurrence rate caused by early operation [1,2], but in practice, other reasons cannot be ignored. Copyright: ©2018 Wang W. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.…”

Section: Commentmentioning

confidence: 99%

“…However, due to the higher recurrence rate and other disadvantages, the procedure is considered unsuitable for low age patients [1,2]. Since most of the children are found to have pectus excavatum shortly after birth, and their families want to complete the operation as soon as possible, it is necessary to design a new procedure to get these children treated.…”

Section: Introductionmentioning

confidence: 99%

Wang procedure: novel minimally invasive procedure for pectus excavatum children with low age

WenLin¹,

Chen²,

Long³

et al. 2018

Case Rep Imag Surg

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Nuss procedure is not suitable for pectus excavatum patients with low age. In order to get these patients treated satisfactorily, we have designed a novel technique with a new concept. We placed a metal bar above the chest wall depression. After lifting with steel wires, the depression is fixed in the middle of the bar, and the deformed chest wall can be well treated. Our experiences show that this method is suitable for the younger pectus excavatum children.After Nuss procedure was reported in 1998, most of the pectus excavatum patients received such operation. However, due to the higher recurrence rate and other disadvantages, the procedure is considered unsuitable for low age patients [1,2]. Since most of the children are found to have pectus excavatum shortly after birth, and their families want to complete the operation as soon as possible, it is necessary to design a new procedure to get these children treated. * TechniqueThe patient is located in the supine position. Skin incision is made in the lower part of the anterior chest wall, just in front of the xiphoid process, with a length of about 2 cm. The soft tissues and muscles are separated to the bottom of the depression just above the surface of the bone structure, then the separation range is enlarged and two tunnels for metal bar are made on both sides of the chest wall. The xiphoid process is exposed and split in the midline longitudinally. After proper traction, the posterior structures behind the sternum are dissociated, and the connection between the diaphragm and the bottom of the sternum is cut off. Three steel wires were sutured through the deformed part of depression, two passing through the costal arches, and one passing through the lower end of the sternum, with the deformed chest wall being completely lifted (Figures 1 and 2). A metal bar is prepared, and its length is about 2 to 3 cm longer than the distance between the highest points on both sides of the depression. The bar is shaped in accordance with the radian of the normal thoracic wall, so that the shape of the bar is equivalent to the patient's chest. Put one end of the bar into the tunnel on one side of the chest wall at first, and then, after reasonable traction, put another end into the opposite tunnel. When

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“…The minimally invasive surgical correction of PE was described by Dr. Donald Nuss and is characterized by the insertion of a metal pre-bent metal bar through two axillary incisions in the retro-sternal space where it remains in place for two to three years [4]. The anterior chest concavity is evident in patients with the malformation, affecting mainly the lower third of the sternum and ribs than the upper two thirds [5].…”

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confidence: 99%

Variations of the soft tissue thicknesses external to the ribs in Pectus Excavatum patients

Rodrigues

Direito-Santos

Moreira

et al. 2013

Journal of Pediatric Surgery

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Background: Surgical repair of pectus excavatum (PE) has become more popular due to improvements in the minimally invasive Nuss procedure. The pre-surgical assessment of PE patients requires Computerized Tomography (CT), as the malformation characteristics vary from patient to patient. Objective: This work aims to characterize soft tissue thickness (STT) external to the ribs among PE patients. It also presents a comparative analysis between the anterior chest wall surface before and after surgical correction. Methods: Through surrounding tissue segmentation in CT data, STT values were calculated at different lines along the thoracic wall, with a reference point in the intersection of coronal and median planes. The comparative analysis between the two 3D anterior chest surfaces sets a surgical correction influence area (SCIA) and a volume of interest (VOI) based on image processing algorithms, 3D surface algorithms, and registration methods. Results: There are always variations between left and right side STTs (2.54 ± 2.05 mm and 2.95 ± 2.97 mm for female and male patients, respectively). STTs are dependent on age, sex, and body mass index of each patient. On female patients, breast tissue induces additional errors in bar manual ☆ Funding: This work was supported by "Fundação para a Ciência e a Tecnologia" (FCT), Portugal, through the R&D project referenced PTDC/SAU-BEB/ 103368

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Minimally Invasive Repair of Pectus Excavatum

Cited by 44 publications

References 35 publications

Minimally invasive repair of pectus excavatum deformity

Minimally invasive repair of pectus excavatum deformity

Wang procedure: novel minimally invasive procedure for pectus excavatum children with low age

Variations of the soft tissue thicknesses external to the ribs in Pectus Excavatum patients

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