Can absorbable stabilizers be used routinely in the Nuss procedure?☆

Pilegaard, Hans K.; Licht, Peter B.

doi:10.1016/j.ejcts.2008.10.049

Cited by 26 publications

(14 citation statements)

References 21 publications

(38 reference statements)

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“…We had no cases of rotation, which we explain by our use of a short bar, which makes it possible to place the stabilizer very close to the entry/exit of the bar through the chest wall, and by that, make the system very stable [5]. The patient with a complicated presentation had a lateral migration of the bars, which was corrected without problems; but, unfortunately, the patient developed infection after the re-operation and did not want to go through a longer treatment with antibiotics; hence, the bars were removed.…”

Section: Discussionmentioning

confidence: 96%

Extending the use of Nuss procedure in patients older than 30 years☆

Pilegaard

2011

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 96%

Extending the use of Nuss procedure in patients older than 30 years☆

Pilegaard

2011

European Journal of Cardio-Thoracic Surgery

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“…The chest is measured from right mid axillary line to left mid axillary line and a pectus bar is selected based on this measurement, minus 2.5 cm (1 inch). Pilegaard has advocated the use of a shorter and eccentrically placed bar with the stabilizer in a more medial position, but this can only be used in patients who have completed their growth spurt (26). The bar is bent into a smooth convex shape such that it fits comfortably against the skin leaving a 2-4 cm flat section in the middle to support the sternum ( Figure 3).…”

Section: Surgical Techniquementioning

confidence: 99%

Nuss bar procedure: past, present and future

Nuss¹,

Obermeyer²,

Kelly³

2016

Ann. Cardiothorac. Surg.

241

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Repair of pectus excavatum began at the beginning of the 20 th century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support. The wide resection resulted in a very rigid anterior chest wall, and in some instances, the development of asphyxiating chondrodystrophy. The primary care physicians therefore became reluctant to refer the patients for repair. In 1987, Nuss developed a minimally invasive technique that required no cartilage or sternal resection and relied only on internal bracing by means of a sub-sternal bar, which is inserted into the chest through two lateral thoracic incisions and guided across the mediastinum with the help of thoracoscopy. After publication of the procedure in 1998, it became widely accepted and a flood of new patients suddenly started to appear, which allowed for rapid improvements and modifications of the technique. New instruments were developed specifically for the procedure, complications were recognized, and the steps taken to prevent them included the development of a stabilizer and the use of pericostal sutures to prevent bar displacement. Various options were developed for sternal elevation prior to mediastinal dissection to prevent injury to the mediastinal structures, allergy testing was implemented, and pain management improved. The increased number of patients coming for repair permitted studies of cardiopulmonary function, which showed that patients with a severe degree of pectus excavatum have right-sided cardiac compression, decreased filling, and decreased stroke volume. The degree of pulmonary restriction and obstruction is related to the degree of deformity and degree of cardiac displacement into the left chest. The indications for surgical repair have been clearly outlined, the procedure has been standardized, and post-operative management protocols are now available. A review of our prospective database showed that 98% of patients have a good to excellent outcome. This review of the "Past" outlines the progression of the surgical techniques during the 20 th century, the review of the "Present" outlines the important modifications and results of the closed technique, and the review of the "Future" outlines the various new options that are becoming available for the treatment of pectus excavatum.

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“…Very soon, we started to use a shorter bar to get the stabilizer closer to the hinge point (8,9) in order to avoid flipping of the bar, and we reduced the numbers of stabilizers to one, which is most often positioned on the left side. During the first phase of using only one stabilizer, we used sutures to secure the bar to a rib on the opposite side of the stabilizer.…”

Section: Interventionmentioning

confidence: 99%

Single centre experience on short bar technique for pectus excavatum

Pilegaard¹

2016

Ann. Cardiothorac. Surg.

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Background: Pectus excavatum (PE) is the most frequent anomaly of the anterior chest wall. Before 2001, all patients in Denmark were referred to the plastic and reconstructive surgeon for implantation of a subcutaneous silicone prosthesis, because the modified Ravitch procedure was not used. Since 2001, all patients have been treated with a modified Nuss procedure, which today has become the gold standard for correction of PE.Methods: From September 2001 to March 2016, 1,713 patients have been operated by a modified Nuss procedure using the short bar at Aarhus University Hospital with a male-female ratio 6:1. The median age was 16 years (range 7-58 years). All operations were done in general anesthesia with epidural analgesia and all patients were operated by the same surgeon. All patients were seen routinely 6 weeks after surgery and the bars were removed after 3 years.Results: Patients were younger than 18 years in 1,109 cases (65%). The number of bars needed for optimal correction was one in 1,209 patients, two in 486 patients and three in 18 patients. The median length of bar changed from 11 inches to 10 inches during the study period. The annual number of procedures continued to rise during the study period [833 patients during the first 10 years and 880 patients in the last 6 years, though more patients received two bars in the later period, (34%) versus (24%)] and the proportion of patients older than 30 years increased from 7.7% to 10%. The average duration of the operation was 36 minutes (range 12-270 minutes) and did not change significantly during the study period, change in operation time which was around half an hour. The median postoperative hospital stay decreased over time from 6 to 2 days. There was no mortality. Conclusions:The modified Nuss procedure with the short bar technique is effective for the correction of PE. The results are stable with a low rate of bar malrotations, and may in most cases can be done in less than an hour in experienced hands.

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Can absorbable stabilizers be used routinely in the Nuss procedure?☆

Cited by 26 publications

References 21 publications

Extending the use of Nuss procedure in patients older than 30 years☆

Extending the use of Nuss procedure in patients older than 30 years☆

Nuss bar procedure: past, present and future

Single centre experience on short bar technique for pectus excavatum

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