Results of Surgical Correction of Funnel-Shaped Deformation of the Chest Children (original) (raw)
Related papers
Pectus excavatum (funnel chest): a historical and current prospective
Surgical and Radiologic Anatomy, 2012
Pectus excavatum (PE) is a relatively common deformity involving the anterior chest wall. It is represented clinically as a conical depression of the sternum and costal cartilages with the apex at the xiphoid process. Associated features and symptoms vary but generally involve respiratory and cardiac abnormalities. Since it's initial description, numerous surgical techniques have been developed to correct PE, with the Ravtich (open) and Nuss (minimally invasive) procedures being the most commonly employed. Although the etiology remains unclear, the pathogenesis of PE is currently thought to involve the overgrowth of the costochondral region of the ribs. In addition, documented case reports of familial pectus excavatum exist, suggesting a heritable form of the defect. Numerous genetic markers have also been discovered, linking PE to various genetic syndromes.
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 2018
Background. Congenital malformations of the chest are observed in 1%–4% of the population, and the most common among these is pectus excavatum (90%). Aim. We aimed to conduct a retrospective multicenter study to compare the effectiveness of various methods of operative removal of pectus excavatum in children. Material and methods. We retrospectively analyzed the results of the surgical treatment of funnel-like deformity of the thorax in children conducted in clinics of pediatric surgery in seven regions of Russia (1,226 patients). The ratio of boys to girls in the study population was 2.2:1. The study population was divided as per their age into the following groups: 4–7 years (n = 180, 14.7%), 8–14 years (n = 731, 59.6%), and > 14 years (n = 315, 25.7%). The average age at which most children were operated was 11.83 ± 1.24 years. All children underwent a standard preoperative laboratory examination, including a general blood test, urine tests, a biochemical blood test, a hemosta...
Operative Correction of Pectus Excavatum
Annals of Surgery, 1976
From 1949 to 1975, 220 children have undergone surgical reconstruction of pectus excavatum using a variety of operations on our Pediatric Surgical Service. The first 183 were previously reported and have had subsequent, careful followup evaluation. From 1970 to 1975, an identifiable group of 45 children had a standard operation, a modified Ravitch repair, with the addition of a three-point or tripod internal fixation technique for support of the sternum. These children have all obtained satisfactory reconstruction without prosthetic support of any kind. We have thus avoided the possible danger of foreign material within the chest and have obviated the need for another procedure to remove a supporting stent. The two groups have been analyzed and compared with respect to age distribution, postoperative complications and end results to see if we could detect any trends in the evolving management of children with this condition. The main indications for surgical correction remain cosmetic and postural. Specific trends which have emerged from our experience include an increased percentage of patients between 3 and 8 years of age (average 5.8 years); a decreased need for blood transfusion (10%); a near resolution of postoperative seromas with the use of substernal and subcutaneous suction drains; and in the last 45 children, a 100% excellent or acceptable result to date. We feel that age selection is an important factor in the improved operative result and in the emotional impact on these young patients. Eighty per cent of the children in the recent series were between 3 and 8 years of age at the time of repair. On the basis of this experience, we now feel confident in recommending our standardized operation for pectus excavatum at an elective age of 4 to 6 years.
Our Experience in the Management of Congenital Chest Wall Deformities
Acta Clinica Croatica, 2007
Chest wall deformities are relatively rare diseases of unknown etiology, which occur in childhood and adolescence. Pectus deformities show familial occurrence with very rare spontaneous resolution. Operative treatment is one of the possible therapeutic options for deformity correction by classic operative procedure or by minimally invasive method of treatment (endoscopic). There is no consensus among surgeons about the age at which correction of the chest wall deformity should best be performed because therapeutic results are very good irrespective of the method of treatment employed. Therapeutic results in 105 patients operated on by the classic method during the 1985-2005 period at
Pectus excavatum from a pediatric surgeon’s perspective
Annals of Cardiothoracic Surgery, 2016
Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. Thus far, genetic studies support an autosomal recessive heritability, which coincides with only 40% of our patients having some positive family history, but is also contradictory given a constant sex ratio of 4:1 in favor of males. This inconsistency may be explained by the effect of more than one pectus disease-associated allele. Once the deformity is noticed, it tends to progress slowly until puberty, when rapid progression is often seen. We recommend surgical repair at around 12-14 years of age since the chest wall is still typically flexible and because this allows us to keep the bar in place as the patient progresses through puberty which may help decrease growth-related recurrences. Patients with mild to moderate PE are treated with therapeutic deep breathing, posturing, and aerobic exercises, and in appropriately selected patients, the vacuum bell may also be offered. Patients that have severe symptomatic PE are offered Minimally Invasive Repair of Pectus Excavatum (MIRPE). The surgical technique in children is similar to that of adults, except for the higher forces involved that often necessitate sternal elevation and more involved stabilization strategies. Postoperative management includes pain control, deep breathing, and early ambulation. Exercise restriction is mandatory for the first six weeks with slow resumption of normal activity after 12 weeks.
Surgical approach to treatment of asymmetric pectus excavatum in children
Paediatric Surgery. Ukraine
Objective. To improve the outcomes in patients with asymmetric pectus excavatum (APE) by developing and implementing our own differentiated modified Nuss procedure to correct different variants of this deformity; to analyse the treatment outcomes. Materials and methods. An original modified Nuss procedure to correct the following pectus excavatum (PE) types is described: asymmetric eccentric focal (ІІА1 according to Park) type; asymmetric eccentric broad-flat (Park ІІА2) type; asymmetric eccentric long canal (the Grand Canyon type or Park IIA3) type; asymmetric unbalanced (Park IIB) type; asymmetric combined (Park IIC) type. The essence of the proposed technique is that at the beginning of the operation, a gradual elevation of the anterior chest wall is carried out to a maximally approximated physiological position using two or more traction ligatures applied to the sternum and ribs. In the future, a horizontal position of the fixation bar is used for asymmetric eccentric focal, asy...
Elastic stable chest repair and its hybrid variants in 86 patients with pectus excavatum
Journal of Thoracic Disease
Background: Complex and mature funnel chest deformities are traditionally managed with open surgical procedures. Elastic stable chest repair (ESCR) has been used successfully and safely for relapse corrections. Does pure plate osteosynthesis in ESCR allow comparable corrective potency and implant safety as hybrid methods with metal bars? Methods: Data from 86 patients with open funnel chest correction between 2011 and 2015 were analyzed in this retrospective study. Exclusion criteria included being under 12 years of age, and having a history of septic wound healing disorder or other malignant diseases. Main groups consisted of ESCR and hybrid techniques, subgroups were primary and recurrence correction. Correction results and follow-up examinations at six and 12 weeks and at 1 year were statistically analyzed. Results: A total of 38 ESCR and 48 hybrid methods were analyzed. Bar implantation was required in 77% (recurrence 34%) of patients. All patients received plates with different combinations e.g., longitudinalsternal, costosternal and costo-sterno-costal. In all groups, follow-up uptake showed a funnel chest correction result at the anatomical level with healthy values according to the Haller index (ESCR 4.36-2.84, hybrid 6.99-2.74, P<0.001). No material dislocations were observed in any subgroup. Conclusions: ESCR and hybrid techniques represent promising and safe therapeutic approaches.
Pectus excavatum in adolescents and children: the Nuss technique
Pediatric Medicine, 2019
Pectus excavatum (PE) is also known as funnel or sunken chest. PE is the most common type of chest wall malformation, indeed occurs in about 1 of 300-400 births with a male predominance (M:F =3:1). It is featured of a depression of the body of the sternum and in association abnormalities of the costal cartilages. The aspect of the defect variant from mild to very severe. PE is frequently asymptomatic during childhood, but symptoms like easy tiredness and decreased hardiness often appear when patients become teenager or are involved in competitive sports. Surgical correction for PE has become rifer thanks to development of the mini-invasive repair (MIRPE), described for the first time by Nuss in 1989. MIRPE consists in a thoracoscopic fixing of at least one metal bar, which is maintained in the chest at least 2 years.
Surgical correction of pectus excavatum: the Münster experience
Langenbeck's Archives of Surgery, 1999
Pectus excavatum is the most common congenital hereditary chest-wall deformity. This study analyses a single-center experience of pectus excavatumthoracic wall reconstruction using a uniform technique of internal stabilization employing stainless steel struts. Methods: From June 1984 to December 1997, we performed correction operations on 777 patients with pectus excavatum. The condition occurred more frequently in boys (621 patients) than girls (156 patients). Surgical repair was performed using a standard method of double bilateral chondrotomy parasternally and at points of transition to normal ribs. This was followed by detorsion of the sternum, retrosternal mobilization and correction of the inverted ribs. The anteriorly displaced sternum was stabilized
Early experience of minimally invasive repair of pectus excavatum in RIPAS Hospital
2012
Introduction: Pectus excavatum (PE) commonly known as sunken chest or funnel chest, is a congenital deformity of the anterior chest wall and is the commonest of all congenital chest wall abnormalities. It can be associated with physical and psychological morbidity. This study evaluates our unit’s experience in performing minimally invasive repair of PE (MIRPE) surgery, also known as “NUSS repair” in teenage patients with PE in RIPAS Hospital. Materials and Methods: Retrospective data analysis of the first seven cases of MIRPE performed at RIPAS Hospital since November 2011, when our MIRPE service was first introduced. Patients’ demographic and operative records of all the cases were retrieved from the Department of Surgery Operation Note database and medical notes. Results: There were five males and one female with a mean age of 17 ± 2.3 years (14.6 – 20.7 years) at the time of repair. The mean Haller index, left ventricular ejection fraction, forced expiratory volume in one second ...