Safety-string: A handy maneuver to control pectus bar removal bleeding complications

Toselli, Luzia; Munzón, Gastón Bellía; Martinez, Jorge; Vallee, Maxroxia; Sanjurjo, Daniela; Peirano, Maximiliano Nazar; Martı́nez-Ferro, Marcelo

doi:10.1016/j.jpedsurg.2020.01.058

Cited by 7 publications

(9 citation statements)

References 8 publications

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“…This relatively low complication rate suggests that straightening of the Nuss bar is not necessary to increase safety of the procedure. Several techniques and maneuvers for removal of the bar have been described so far (1)(2)(3)(4)(5)(6)(7)(8)17). Our method of removal consists of extraction along the thoracic curvature without prior straightening while the patient is positioned (19,20) as also used in the present study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nuss bar removal without straightening is a safe technique: a single center experience

Janssen¹,

Daemen²,

Ashour³

et al. 2022

J Thorac Dis

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Background: A Nuss bar often placed to correct pectus excavatum is usually removed after a period of 2 to 3 years. Bar removal can result in potentially life-threatening complications. To minimize this risk, a recent systematic review recommends in-situ straightening of the bar before removal. Alternatively, the bar can be removed without straightening by extraction along the thoracic curvature. This study reports our singlecenter experience with this latter technique for bar removal, with focus on perioperative complications.Methods: A single-center retrospective observational cohort study was conducted. Consecutive patients undergoing Nuss bar removal between 2011 and 2020 were eligible for inclusion. The primary outcome was the incidence of perioperative complications. Secondary outcomes included duration of operation, blood loss, and length of postoperative hospital stay.Results: A total of 331 patients were included. Of these, 288 (87%) were male with a median age of 20 years [interquartile range (IQR), 19-26 years]. Perioperative complications occurred in a total of 4 patients (1%) following Nuss bar removal. Two patients (0.6%) experienced major complications (deep incisional surgical site infection and hemothorax respectively); there was no mortality. The median duration of surgery was 30 minutes (IQR, 20-40 minutes). Patients were discharged after a median postoperative stay of 1 day (IQR, 1-1 day).Conclusions: Nuss bar removal without prior in-situ bar straightening appears to be a safe and effective technique. It is associated with a low complication rate of 1%.

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Section: Discussionmentioning

confidence: 99%

“…Removal of the bar is generally considered to be a nondemanding procedure. Notwithstanding, it is associated with rare but potentially life-threatening complications such as bleeding from the pericardium, heart, and internal thoracic vessels when the bar is removed from its substernal tunnel (1)(2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Nuss bar removal without straightening is a safe technique: a single center experience

Janssen¹,

Daemen²,

Ashour³

et al. 2022

J Thorac Dis

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“…Campos proposed to cover the serrated edges of the implants with a protective film at bar removal to minimize hemorrhagic complications (25). Toselli uses a safety string at all bar removals, and in case of bleeding a sponge or Sangstaken Blakemore catheter can be attached to it and can be dragged into the tunnel to control the hemorrhage (26). We have examined, whether removing those bars which were compressing the IMA-s increase the risk of intraoperative hemorrhage, and if these bar removals should be performed with extra precautions, for example, thoracoscopic control.…”

Section: Discussionmentioning

confidence: 99%

Internal Mammary Artery Compression After Pectus Excavatum Repair Does Not Increase Risk of Hemorrhagic Complications in Pediatric Patients

2021

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Objectives: Minimal invasive repair of pectus excavatum (MIRPE) described by Nuss is the most popular correction nowadays of this deformity. During the introduction of the bars, they can hurt or compress the internal mammary arteries (IMA). The aim of this study was to observe the prevalence of IMA compression in children after MIRPE. Also, we examined if IMA obstruction increases the risk of complications at bar removal, and if these vascular changes are reversible.Materials and Methods: All patients operated on pectus excavatum in our tertiary pediatric surgical center between 2013 and 2019 were involved in the study. Data of age, sex, number of bars and characteristics of the deformity were examined. IMA flow was checked by Doppler ultrasound (DUS) after MIRPE and after bar removal, too.Results: Among 41 patients with mean age of 15.2 years there were 18 asymmetrical deformities, 23 sternal rotations. Mean pectus index was 4.01. After the Nuss procedure 7(9%) stenoses and 10(12%) occlusions of IMA were found on DUS. After bar removal 3 of 4 stenoses have resolved, but all examined occlusions (3/3) persisted. There were no complications during bar removals.Conclusion: IMA compression after MIRPE in children is uncommon, and is not influenced by severity of deformity. Obstruction of these vessels does not increase the risk of hemorrhagic complications at bar removal. Data of larger cohort are needed to determine reversibility of these changes.

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“…Other protective techniques such as covering the serrated edge of the bar to reduce injury, and tying an umbilical tape and sponge to the end of the bar as it is pulled through the tract to tamponade any bleeding have been proposed (61,62).…”

Section: Minimally Invasive Repair Of Pectus Excavatum (Mirpe)mentioning

confidence: 99%

“…It is generally recommended to re-open both lateral incisions used for initial bar placement and to straighten the bar prior to removal, though some authors have proposed techniques that do not require unbending of the bar ( 58 - 60 ). Other protective techniques such as covering the serrated edge of the bar to reduce injury, and tying an umbilical tape and sponge to the end of the bar as it is pulled through the tract to tamponade any bleeding have been proposed ( 61 , 62 ).…”

Section: Pectus Excavatum Managementmentioning

confidence: 99%

The management of pectus excavatum in pediatric patients: a narrative review

Scalise¹,

Demehri²

2023

Transl Pediatr

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Background and Objective: Pectus excavatum is the most common congenital chest wall anomaly, the hallmark of which is the caved-in appearance of the anterior chest. A growing body of literature exists surrounding methods of surgical correction, though considerable variability in management remains. The primary objectives of this review are to outline the current practices surrounding the care of pediatric patients with pectus excavatum and present emerging trends in the field that continue to impact the care of these patients.

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Safety-string: A handy maneuver to control pectus bar removal bleeding complications

Cited by 7 publications

References 8 publications

Nuss bar removal without straightening is a safe technique: a single center experience

Nuss bar removal without straightening is a safe technique: a single center experience

Internal Mammary Artery Compression After Pectus Excavatum Repair Does Not Increase Risk of Hemorrhagic Complications in Pediatric Patients

The management of pectus excavatum in pediatric patients: a narrative review

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