TECHNOLOGY OF MINIMALLY INVASIVE SURGICAL CORRECTION FUNNEL-SHAPED DEFORMATION OF THE CHEST IN CHILDREN

Authors

DOI:

https://doi.org/10.15674/0030-59872024334-40

Keywords:

Pectus excavatum, thoracoplasty, complications, children

Abstract

The most common method surgical treatment of pectus excavatum (PE) is thoracoplasty according by D.Nuss at the moment. But serious complications associated with trauma to the pericardium, blood vessels, and bleeding are known. Objective. Development of a modified technology surgical correction of pectus excavatum, which involves exclusively extrapleural passage of the plate, according to the individual size and shape of the deformation of the patient’s chest, in order to prevent intraoperative complications. Methods. 81 patients aged 10 to 17 years were involved in the study. A modified technology of extrapleural surgical correction of PE was performed. The plate was carried level of the VI–VII sternocostal joints through the formed through submuscular-extrapleural retrosternal tunnel from right to left under control of right-sided thoracoscopy. The plate was modeled according by individual deformation parameters chest. The analysis was carried out according to the following criteria: age, gender, type of deformity, Haller index, duration of surgery, intraoperative and early postoperative complications according by Clavien–Dindo classification. Results. The median age of patients was (13.8 ± 1.9) years, of which there were 65 (85.25 %) boys, 16 (19.75 %) girls. 48 (59.3 %) children were diagnosed with type I (symmetric) deformity, and 33 (40.7 %) with type II (asymmetric) according to the classification. The median Haller was (4.07 ± 0.62), which corresponds to 2–3 degrees. Differences in the degree of deformation in children of different sexes were not determined (р = 0.828). Impaired lung function was d iagnosed i n 55.55 % (n = 45), i mpaired h eart f unction — 40.74 % (n = 33). T he d uration of the o peration was on a verage (70.6 ± 15.4) minutes, from 50 to 110 minutes. Early postoperative complications were found in 5 (6.17 %) patients classified as grade I (mild) according to the Clavien–Dindo classification, which did not require additional medical or surgical correction. After the operation, the correction of chest deformation was on average (2.35 ± 0.22) according by Haller index, which was statistically significantly (р = 0.001) different from the initial level. Conclusions. The use of modified technology surgical correction of PE meets safety requirements and minimizes postoperative complications.

Author Biography

Valery Dihtiar, Dnipro State Medical University. Ukraine

MD, Prof

References

  1. Nuss, D., Obermeyer, R. J., & Kelly, R. E. (2016). Nuss bar procedure: past, present and future. Annals of cardiothoracic surgery, 5(5), 422–433. https://doi.org/10.21037/acs.2016.08.05
  2. Scalise, P. N., & Demehri, F. R. (2023). The managementof pectus excavatum in pediatric patients: a narrative review. Translational pediatrics, 12(2), 208–220. https://doi. org/10.21037/tp-22-361
  3. Brungardt, J. G., Chizek, P. W., & Schropp, K. P. (2021). Adult pectus excavatum repair: national outcomes of the Nuss and Ravitch procedures. Journal of thoracic disease, 13(3), 1396–1402. https://doi.org/10.21037/jtd-20-2422
  4. Haecker, F. M., Hebra, A., & Ferro, M. M. (2021). Pectus bar removal — why, when, where and how. Journal of pediatric surgery, 56(3), 540–544. https://doi.org/10.1016/j.jpedsurg.2020.11.001
  5. Shi, R., Xie, L., Chen, G., …, Ben, X., & Qiao, G. (2019). Surgical management of pectus excavatum in China: results of a survey amongst members of the Chinese association of thoracic surgeons. Annals of translational medicine,7(9), 202. https://doi.org/10.21037/atm.2019.05.03
  6. Nuss, D., Kelly, R. E., Jr, Croitoru, D. P., & Katz, M. E. (1998). A 10-year review of a minimally invasive technique for the correction of pectus excavatum. Journal of pediatric surgery, 33(4), 545–552. https://doi.org/10.1016/s0022-3468(98)90314-1
  7. Goretsky, M. J., & McGuire, M. M. (2018). Complications associated with the minimally invasive repair of pectus excavatum. Seminars in pediatric surgery, 27(3), 151–155. https://doi.org/10.1053/j.sempedsurg.2018.05.001
  8. Bilgi, Z., Ermerak, N. O., Laçin, T., Bostancı, K., & Yüksel, M. (2016). Previously complicated nuss procedure does not preclude blind removal of the bar. The thoracic and cardiovascular surgeon, 64(1), 83–86. https://doi.org/10.1055/s-0035-1564690
  9. Hebra, A., Kelly, R. E., Ferro, M. M., Yüksel, M., Campos, J. R. M., & Nuss, D. (2018). Life-threatening complications and mortality of minimally invasive pectus surgery. Journal of pediatric surgery, 53(4), 728–732. https://doi.org/10.1016/j.jpedsurg.2017.07.020
  10. Obermeyer, R. J., Goretsky, M. J., Kelly, R. E., Jr, Frantz, F. W., Kuhn, M. A., McGuire, M. M., Duke, D. S., & Paulson, J. F. (2021). Selective use of sternal elevation before substernal dissection in more than 2000 Nuss repairs at a single institution. Journal of pediatric surgery, 56(4), 649–654. https://doi.org/10.1016/j.jpedsurg.2020.07.005
  11. Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classificationof surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery, 240(2), 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  12. Digtyar, V. A., Kaminska, M. O., & Yaresko, O. V. (2021). Mathematical calculation and value of the coefficient of restoration of the shape of the chest when planning thoracoplasty of congenital funnel-shaped deformation of the chest. Trauma, 22(1), 45–51. https://doi.org/10.22141/1608-1706.1.22.2021.226408 (in Ukrainian)
  13. Kaminska, M. O., Digtyar, V. A., Yaresko, O. V. (2021). Mathematical modeling of the chest, its funnel-shaped deformation and thoracoplasty. Orthopedics, traumatology and prosthetics, 2, 17–22. https://doi.org/ 10.15674/0030-598720212 (in Ukrainian)
  14. Park, H. J., Lee, S. Y., Lee, C. S., Youm, W., & Lee, K. R. (2004). The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. The Annals of thoracic surgery, 77(1), 289–295. https://doi.org/10.1016/s0003-4975(03)01330-4
  15. Nuss, D., Croitoru, D. P., Kelly Jr., R. E., Goretsky, M. J., Nuss, K. J., & Gustin, T. S. (2002). Review and discussion of the complications of minimally invasive Pectus Excavatum repair. European journal of pediatric surgery, 12(4), 230–234. https://doi.org/10.1055/s-2002-34485
  16. Mennie, N., Frawley, G., Crameri, J., & King, S. K. (2018). The effect of thoracoscopy upon the repair of pectus excavatum. Journal of pediatric surgery, 53(4), 740–743. https://doi.org/10.1016/j.jpedsurg.2017.07.019
  17. Zhang, D. K., Tang, J. M., Ben, X. S., Xie, L., Zhou, H. Y., Ye, X., Zhou, Z. H., Shi, R. Q., Xiao, P., & Chen, G. (2015). Surgical correction of 639 pectus excavatum cases via the Nuss procedure. Journal of thoracic disease, 7(9), 1595–1605. https://doi.org/10.3978/j.issn.2072-1439.2015.09.30
  18. Pawlak, K., Gąsiorowski, Ł., Gabryel, P., & Dyszkiewicz, W. (2018). Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

Downloads

How to Cite

Kaminska, M. ., & Dihtiar, V. . (2024). TECHNOLOGY OF MINIMALLY INVASIVE SURGICAL CORRECTION FUNNEL-SHAPED DEFORMATION OF THE CHEST IN CHILDREN. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (3), 34–40. https://doi.org/10.15674/0030-59872024334-40

Issue

No. 3 (2024)

Section

ORIGINAL ARTICLES

License

Copyright (c) 2024 Маріанна Камінська, Валерій Дігтяр

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.

Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.

The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).