Modified Method for Correction of Pectus Excavatum in Children

Abstract

Background. Chest deformities occur in 7% of the population, of them funnel deformation of the thorax constitutes more than 80%. Surgical correction appears to be the only way to change the configuration of the chest. The Nuss procedure is the "gold standard" to correct this deformity. This technique was modified in the clinic of the Department of Pediatric Surgical Diseases, Siberian State Medical University, Tomsk. The necessity to compare the Nuss procedure and its modified option has arisen due to accumulated experience in surgical interventions performed.The aim of the study was to describe a modified technique of the funnel deformation of the thorax and assess its effectiveness compared to the classical Nuss procedure.Material and methods. The study included results of surgical treatment of 94 children, both sexes, aged 10 to 17 years, who had the funnel deformation of the thorax. All patients were divided into two groups: the main group (45 patients), where a modified technique of surgical correction was applied, and the comparison group (49 patients), where the classical Nuss procedure was applied for the deformity correction. For the surgical correction of the funnel deformity of the thorax, improved plates made of smooth titanium nickelide were used to fix the sternocostal complex in children of the main group. The following criteria were selected to compare the effectiveness of two surgical options of the funnel deformation correction: intraoperative parameters, Gizycka index, the scale of role functioning SF-36, VAS of pain and the number of complications. The arithmetic mean number was derived based on the above criteria - the total efficiency coefficient; clinical results were defined depending on this coefficient - good, satisfactory and unsatisfactory.Results. The number of good results in patients of the main group, where modified surgery technique was applied, was 62.3% compared to 38.8% in patients who were exposed to the Nuss procedure. The number of satisfactory results in patients of the main group was 35.5% compared to 34.7% in patients of the comparison group. It should be noted that the use of the modified technique had unsatisfactory results in 2.2% of cases (in 1 patient), while the use of the conventional Nuss procedure resulted in unsatisfactory outcomes in 26.5% of cases.Conclusions. Clinical outcomes of surgical correction performed using modified technique of the Nuss procedure are more beneficial in terms of the duration of intervention, the volume of blood loss, and the number of postoperative complications. This technique allows minimizing invasiveness of the procedure and starting early rehabilitation.