Short-term results of minimally invasive pectus excavatum repair in adult patients
Authors:
M. Lučenič; M. Janík; P. Juhos; A. Garchar
Authors place of work:
Klinika hrudníkovej chirurgie SZU a UN Bratislava
prednosta: prof. MUDr. S. Haruštiak, CSc.
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 1, s. 25-32.
Category:
Original articles
Summary
Introduction:
Pectus excavatum is the most common congenital chest wall deformity. Aproximatelly 1 out of 400 to 1000 newborns are affected by this diagnosis. Surgical correction is indicated in patients that fulfil the indication criteria. The highly modified Ravitch correction (HMRR) and minimally invasive pectus excavatum repair (MIRPE) are by far the most popular methods of correction. MIRPE has been established as the method of choice amongst children. Feasibility of the minimally invasive approach in the funnel chest correction in adult population still remains controversial.
Methods:
The authors present a retrospective analysis of adult patients treated by MIRPE in their institution. Sixty adult patients with pectus excavatum underwent MIRPE from October 2010 to March 2015. Various parameters were evaluated retrospectively. The effectiveness and safety of both techniques were evaluated with the use of statistical software SPSS® version 21.0 (IBM, USA). Data were evaluated using Student´s t-test or Mann-Whitney U-test for normally and non-normally distributed data, respectively. The comparison of categorical variables between the groups was evaluated by Pearson´s chi-square test. A p value of less than 0.05 was considered statistically significant.
Results:
45 men and 15 women underwent MIRPE during the period. Median age in the group was 23 years without any statistically significant difference between males and females (p=0.386). Median Haller index was 3.93 and was slightly higher in women (p= 0.285). Asymmetric deformities were present in 20 patients (33.3%) without any statistically significant difference between the sexes (p=0.206). Median duration of the surgical correction was 73 minutes and was longer in males (p=0.312). Two bars were implanted in 27 patients with no significant difference between the sexes (p=0.454). Complication rate was 25% (15/60) without any significant difference based on the number of implanted bars (p=0.178), sex (p=0.863) or the presence of an asymmetric deformity (p=0.527). Wound seromas with 10% (6/60) were the most common complication. Median postoperative length of stay was 5 days without any significant difference between males and females (p=0.653) and patients with different number of bars implanted (p=0.600). The need for rehospitalisation and reoperation was indicated in 5 patients (8.3%). Allergy to chromium led to bar extraction in 1 patient and 4 patients were treated by V.A.C.® therapy (KCI, USA) because of wound abscess (1) and seroma (3).
Conclusion:
Minimally invasive pectus excavatum repair is an effective surgical technique for the treatment of pectus excavatum in adult patients. This technique can be learned and performed safely even without any former experience with this correction in children.
Key words:
adult patients – MIRPE − pectus excavatum
Zdroje
1. Goretsky MJ, Kelly RE, Croitoru D, et al. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin 2004;15:455−71.
2. Krasopoulos G, Goldstraw P. Minimally invasive repair of pectus excavatum deformity. Eur J Cardiothorac Surg 2011;39:149−58.
3. Pilegaard HK, Licht PB. Routine use of minimally invasive surgery for pectus excavatum in adults. Ann Thorac Surg 2008;86:952−6.
4. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 Patients. Ann Surg 2010;252:1072−81.
5. Kragten HA, Siebenga J, Höppener PF, et al. Symptomatic pectus excavatum in seniors (SPES): a cardiovascular problem?: A prospective cardiological study of 42 senior patients with a symptomatic pectus excavatum. CORD Conference Proceedings 2011;19:73−8.
6. Jaroszewski DE, Fraser JD, Notrica DM. Pectus excavatum in the adult: Current treatment modalities, in difficult decisions in thoracic surgery an evidence- based approach. Second edition Dordtrecht, London, Berlin, Heidelberg, Springer Verlag 2011:504.
7. Pilegaard HK. Extending the use of Nuss procedure in patients older than 30 years. Eur J Cardiothorac Surg 2011;40:334−8.
8. Yoon Y, Kim H, Choi Y, et al. A modified Nuss procedure for late adolescent and adult pectus excavatum. World J Surg 2010;34:1475−80.
9. Esteves E, Paiva KCC, Calcagno-Silva M, et al. Treatment of pectus excavatum in patients over 20 years of age. J of Laparoendosc Adv Surg Tech 2011;21:93−6.
10. Nagasao T, Miyamoto J, Ichihara K, et al.Age-related change of postoperative pain location after Nuss procedure for pectus excavatum. Eur J Cardiothorac Surg 2010;38:203−9.
11. Cheng YL, Lee SC, Huang TW, et al. Efficacy and safety of modified bilateral thoracoscopy- assisted Nuss procedure in adult patients with pectus excavatum. Eur J Cardiothorac Surg 2008;34:1057−61.
12. Aronson D, Bosgraaf R, van der Horst C, et al. Nuss procedure: Pediatric surgical solution for adults with pectus excavatum. World Journal of Surgery 2007;31:26−9.
13. Kim H, Hwang JJ, LeeMK, et al. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg 2005;80:1073−7
14. Olbrecht VA, Arnold MA, Nabaweesi R, et al. Lorenz bar repair of pectus excavatum in the adult population: Should it be done? Ann Thorac Surg 2008;86:402−9.
15. Schalamon J, Pokall S, Windhaber J, at al. Minimally invasive correction of pectus excavatum in adult patients. J Thorac Cardiovasc Surg 2006;132:524−9.
16. Rushing GD, Goretsky MJ, Gustin T, et al. When it is not an infection: metal allergy after the Nuss procedure for repair of pectus excavatum. J Pediatr Surg 2007;42:93−7.
17. Fonkalsrud EW, Mendoza J, Finn PJ, et al. Recent experience with open repair of pectus excavatum with minimal cartilage resection. Arch Surg 2006;141:823−9.
18. Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience. J Thorac Dis 2015:S172−S6.
19. de Oliveira Carvalho PE, da Silva MVM, Rodrigues OR, et al. Surgical interventions for treating pectus excavatum. Cochrane Database Syst Rev 2014;10 [cit. 2015-05-22]. Dostupný na http://onlinelibrary. wiley.com/doi/10.1002/14651858. CD008889.pub2/pdf.
20. Hebra A, Jacobs J, Feliz A, et al. Minimally invasive repair of pectus excavatum in adult patients. Am Surg 2006;72:837−42
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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