Surgical Correction of Pectus Excavatum by the Nuss Procedure: A 15-Year Experience Study

Cierpikowski, Piotr; Rzechonek, Adam; Błasiak, Piotr; Lisowska, Hanna; Pniewski, Grzegorz; Pivert, Patric Le

doi:10.1007/5584_2017_121

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…10 12 Cierpikowski et al described an overall increase in complications with the placement of multiple bars, although specific complications were not detailed. 13 With univariate analysis, our study identified a significant increase in odds of pleural effusion, postoperative thoracostomy tube placement, and readmission. After further controlling for possible confounding variables, multivariate analysis confirmed an increase in odds of readmission.…”

Section: Discussionmentioning

confidence: 76%

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

et al. 2021

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Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.

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Section: Discussionmentioning

confidence: 76%

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

et al. 2021

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“…Починаючи з перших публікацій методики у 1998 р. D. Nuss, у всьому світі відбулася революція в лікуванні цієї патології. Провідні хірурги, які займаються ЛДГК, почали працювати в напрямку вдосконалення методики, пріоритетом, звичайно ж, залишалася безпечність операції [4,8,9]. Так, процедура корекції запалої грудної клітки за методикою Nuss передбачає торакоскопічний контроль, що дає змогу безпечніше виконувати маніпуляції всередині грудної клітки та забезпечувати адекватний гемостаз, за потреби [12].…”

Section: оригінальні дослідження торакальна хірургіяunclassified

Evolution of methods of surgical correction of pectus excavatum in children: single center experience

Levytskyi

Pylypko

Godik

et al. 2021

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Pectus excavatum (PE) in children is the most common pathology among orthopedic diseases of the anterior chest wall. Today in the world the main direction of scientific research in the surgical correction of this pathology is safety during surgery for the patient and the introduction of minimally invasive techniques. Purpose – to conduct a comparative analysis of the results of thoracoplasty in children with PE using different surgical techniques to reduce trauma and duration of surgery and blood loss; to study the optimal correction results to accelerate psycho-physical adaptation after the Nuss procedure. Materials and methods. The treatment of 289 patients operated on for PE in the orthopedic and traumatology department of National Children’s Specialized Hospital «OKHMATDYT» were analyzed. According to the methods of thoracoplasty used, patients were divided into 3 groups. In the first group (n=112) PE correction was performed using Nuss operation with subxiphoid access and tactile control during the retrosternal bar placement; in the second group (n=79) Nuss procedure was performed under thoracoscopic control, where one retrosternal T-shaped bar with additional lateral stabilizer was implanted and fixed on the ribs with a resorbable suture or wire; in the third group (n=98) surgical treatment of PE was performed using the Nuss procedure under thoracoscopic control using a fixator consisting of two retrosternal bars-arches, which are interconnected by lateral bars, the «Bridge» technique. Results. When using thoracoscopic control and temporary sternum elevation by modificated «Park crane» during the correction of PE, the time of surgery and blood loss was reduced. No rotations of the fixator throughout the observation period and lower postoperative pain syndrome were observed in patients of the 3rd group, who underwent corrections with the «Bridge technique». Conclusions. The technique of minimally invasive correction of pectus excavatum (MIRPE), Nuss operation, using thoracoscopic control and temporary elevation of the sternum during pectus bar placement is a safe and effective method of thoracoplasty. The use of two plates (the «Bridge» system) during minimally invasive correction is the operation of choice for adolescent children with funnel chest deformities. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pectus excavatum; chest deformity; Nuss operation, surgery, pediatrics, thoracoplasty, results.

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“…However, in the case of adults, the original Nuss procedure requires some modifications [Jaroszewski et al, 2018]. A 15 year-experience in Nuss surgical correction of 239 patients aged between 14-34 are summarized in the study [Cierpikowski et al, 2018]. The authors observed beneficial long-term effects in 96.7% of the pectus patients, and postoperative complications in 16.9% of them, mostly in the adult patients with asymmetric chest deformations.…”

Section: Chest Wall Deformations and Their Treatmentmentioning

confidence: 99%

Implant Safety Tool Application to Assist the Assessment of Radio-Frequency Radiation Exposure

Gas¹,

Miaskowski²

2019

J. Ecol. Eng.

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This paper discusses a new Implant Safety Tool, used to assess the safety of patients with metal implants exposed to radio-frequency (RF) fields. This specialist tool is discussed on the example of pectus patients with titanium bar-implant inserted during the minimally invasive Nuss procedure. The authors created a 3D realistic model of a 34-year-old male patient with a Nuss bar-implant. A numerical analysis based on the finite-difference time-domain (FDTD) method was performed for a far field source in the form of a plane wave with the frequency of 64 MHz, which corresponds to the RF exposure generated by MRI devices at 1.5 T. The obtained results allow concluding that the concave Nuss bar-implant poses no risk during environmental and occupational RF field exposures.

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Surgical Correction of Pectus Excavatum by the Nuss Procedure: A 15-Year Experience Study

Cited by 7 publications

References 26 publications

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

Evolution of methods of surgical correction of pectus excavatum in children: single center experience

Implant Safety Tool Application to Assist the Assessment of Radio-Frequency Radiation Exposure

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