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

Scalise, P. Nina; Demehri, Farokh R.

doi:10.21037/tp-22-361

Cited by 14 publications

(15 citation statements)

References 91 publications

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“…Among the complications of PE orthopedic surgery, the most troublesome problem for surgeons is the postoperative rejection of the inserted plate [13] . Mild to moderate rejection can lead to incision infection, non-healing incision, and delayed postoperative hospitalization, which not only increases the psychological burden of patients, but also greatly affects the therapeutic effect of surgery and postoperative quality of life, and some patients with delayed incision healing will have scarring of the skin tissue after recovery [6,13,17] . Patients with moderate to severe rejection can suffer from serious complications such as chest infection and eventually early removal of the placed plate leading to orthopaedic failure.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Suspension procedure compared with Nuss procedure in Pectus excavatum:A propensity score matching analysis

Zhang,

Pang,

Wang

2023

Preprint

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Introduction：Suspensions operation is a minimally invasive surgical treatment in pectus excavatum recently. Process of suspensions does not need to enter the pleural cavity, and thus avoid the heart, pericardium or lung tissue damage to the greatest degree. Through this study, we developed suspensions operation as an alternative option for the treatment of pectus excavatum. Material and Methods: Of 104 pectus excavatum patients corrected with nuss procedure and suspensions between January 2016 and 2021. Propensity score matching (PSM) was performed for age, sex, Haller index involvement in a 1:1 ratio between the two group, the primary safety endpoint was the presence of surgical complications, and the primary efficacy endpoint was Haller index measured postoperatively in each group. Secondary endpoints were and hospital length of stay (LOS), duration of surgical procedure, and postoperative pain degree. Chi-square, Student t test or one-way analysis of variance (ANOVA) were used for comparison as appropriate. Results: There are no differences between Nuss and Suspension procedures in major surgical complications. The efficacy endpoint was measured 18 months after the procedure, presenting a similar efficiency after surgery, Haller index :[Nuss 3.3（2.6-3.7） and Suspension（2.8-3.7）postoperatively, P = .14], measured by CT scan .There are significant differences between Nuss and Suspension procedures in minor surgical complications, patients undergo suspension surgery required less surgical time (35 ±11 versus 75±22 minutes, P < .01) and had shorter LOM (2±1.6 versus 6±2.2days, P < .01) and hospital LOS (5±2.2 versus 2±1.5 days, P < .01). Evaluating the postoperative pain grade of each group, fewer patients with suspension have 4 Grade of pian [Suspension 7 (21.8%) versus Nuss 17(53.1%), P < .05]. Conclusion: In this propensity-matched score analysis, patients with pectus excavatum, both surgical approaches have the same reliable surgical safety and outcome, and the suspension approach has the advantage of being simpler, less risky, and less painful for the patient after surgery, making suspension surgery an option for minimally invasive orthopedic surgery in these patients.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Suspension procedure compared with Nuss procedure in Pectus excavatum:A propensity score matching analysis

Zhang,

Pang,

Wang

2023

Preprint

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“…PE occurs in about 1 out of every 400 individuals ( 36 ). Studies have reported that patients with PE suffer from body image dissatisfaction and thus avoid social situations ( 37 - 39 ).…”

Section: Discussionmentioning

confidence: 99%

Quality of life with minimally invasive repair of pectus excavatum: a systematic review and meta-analysis

Mohamed,

Tan,

Tam

2023

Ann Transl Med

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Background Minimally invasive repair of pectus excavatum (MIRPE) is a popular method for surgical correction of PE, and its impact on quality of life is a growing area of interest. We performed a systematic review and meta-analysis to evaluate the impact of MIRPE on the quality of life of patients. Methods This study was registered with PROSPERO under reference number CRD42020222061. A literature search of PubMed, Cochrane Library, EMBASE and Scopus was conducted from the date of inception till November 23, 2020. We included studies which administered one or more questionnaires on patients up to 60 years old, parents or both, to assess the quality of life before and after MIRPE. Studies not written in English, abstracts, articles without primary data, reviews and studies which combined data on PE and other deformities were excluded. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions and the Cochrane risk of bias tool. A random-effects meta-analysis was performed to obtain mean differences for key themes of quality of life before and after MIRPE. Responses from the same questionnaires, as well as common themes across different questionnaires, were compared. Results Of the 20 studies identified for systematic review, 7 studies that reported the responses of 478 patients were included in the meta-analysis. Patients who underwent MIRPE experienced an increased self-esteem [standardized mean difference (SMD): 1.38, 95% confidence interval (CI): 0.95 to 1.81, P<0.00001] and a smaller degree of chest interference with their social activities (SMD: 0.84, 95% CI: 0.60 to 1.08, P<0.00001). These findings were consistent even after the implanted bar was removed. Conclusions MIRPE may be associated with a better quality of life for patients with PE as self-esteem and extent of chest interference with social activities are improved after the procedure. The key limitations of this study are the lack of high-quality evidence due to paucity of randomized trials, and the significant heterogeneity in reported outcomes due to variations in the questionnaires and timepoints of administration.

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“…The ESP 'single shot' blockade has the beneficial effect of reducing the amount of opioids needed. It resulted in a reduction in the total dose of opioids and the occurrence of adverse effects after pharmacotherapy [30,31]. Cryoablation performed together with the 'single shot' ESP blockade is therefore a safer option compared to keeping the catheter to continue regional analgesia for several days.…”

Section: Discussionmentioning

confidence: 99%

Benefits of the Erector Spinae Plane Block before Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity

Zacha,

Jarosz,

Kokot

et al. 2023

JPM

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Thoracic surgery causes significant pain despite standard multimodal analgesia. Intraoperative cryoanalgesia may be a solution. The onset of the clinical effect of cryoanalgesia can take 12–36 h. The addition of a regional anaesthesia before the cryoanalgesia procedure can enable analgesic protection for the patient during this period. The main aim of the study was to evaluate the benefits of the erector spinae plane (ESP) block prior to Nuss surgery. The ‘control’ group consisted of 10 teenagers who underwent cryoablation together with intravenous multimodal analgesia according to the standard protocol. The ‘intervention’ group included 26 teenage patients who additionally received an erector spinae plane block before operation. Pain relief (p = 0.015), opioid use (p = 0.009), independent physical activity and rehabilitation (p = 0.020) were faster in the intervention group. No features of local anaesthetic drug toxicity or complications of the ESP block were observed. The bilateral ESP block together with intraoperative intercostal nerve cryoablation performed prior to Nuss correction of funnel chest were more effective in terms of pain control.

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

Cited by 14 publications

References 91 publications

Safety and Efficacy of Suspension procedure compared with Nuss procedure in Pectus excavatum:A propensity score matching analysis

Safety and Efficacy of Suspension procedure compared with Nuss procedure in Pectus excavatum:A propensity score matching analysis

Quality of life with minimally invasive repair of pectus excavatum: a systematic review and meta-analysis

Benefits of the Erector Spinae Plane Block before Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity

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