Early and Late Results of the Nuss Procedure in Surgical Treatment of Pectus Excavatum in Different Age Groups

Pawlak, Krystian; Gąsiorowski, Łukasz; Gabryel, Piotr; Gałęcki, Bartłomiej; Zieliński, Paweł; Dyszkiewicz, Wojciech

doi:10.1016/j.athoracsur.2016.04.098

Cited by 63 publications

(56 citation statements)

References 28 publications

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“…In addition, correction of PE had some significant effects on TS. The optimal age for the correction of the deformity is a controversial issue (14)(15)(16)(17). However, these findings suggest that early correction of PE can reduce TS in patients with PE (11,13).…”

Section: Discussionmentioning

confidence: 99%

Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum

Park¹,

Kim²,

Park³

et al. 2017

J. Thorac. Dis.

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Section: Discussionmentioning

confidence: 99%

Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum

Park¹,

Kim²,

Park³

et al. 2017

J. Thorac. Dis.

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“…The procedure initially involves the introduction of one or more curved stainless-steel bars behind the sternum to correct the chest wall without resection of the costal cartilages. Considering that the procedure was widely accepted, it has been used extensively in children, adolescents, and adults in the past decade [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Minimization of the complications associated with bar removal after the Nuss procedure in adults

Hsieh

Tong

Wei

et al. 2020

J Cardiothorac Surg

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Background: Pectus bar removal after Nuss repair is associated with the risk of major complications that are underreported. Of these, surgical bleeding is the main concern. Old age and placement of more than one bar are reported risk factors for pectus bar removal. In this study, we presented our experience regarding the modified skills required to minimize complications during bar removal, especially in adult patients. Methods: Consecutive patients who underwent pectus bar removal as the final stage of Nuss repair between August 2014 and December 2018 were included. The patients were positioned in the supine position. The bar(s) was (were) removed from the left side via the bilateral approach using the previous surgical scars after full dissection of the ends of the bar lateral to the hinge point and after straightening the right end of the bar. Bleeding was carefully checked after removal. An elastic bandage was wrapped around the chest after wound closure to prevent wound hematoma/seroma formation. Results: A total of 283 patients (260 male and 23 female), with a mean age of 22.8 ± 6.6 years at the time of the Nuss repair were included. The mean duration of pectus bar maintenance interval was 4.3 years (range: 1.9 to 9.8 years). A total of 200 patients (71%) had two bars. The mean estimated blood loss was 11.7 mL (range: 10 mL to 100 mL). Nine patients (3.1%) experienced complications, six had pneumothorax and three had wound hematoma. No major bleeding occurred. Adults and the use of more than one bar were not associated with a significantly higher rate of complications (P = 0.400 and P = 0.260, respectively). Conclusions: Adult patients and removal of multiple bars were not risk factors for complications in our cohort. Skill in preventing intraoperative mediastinal traction, carefully controlling bleeding, and reducing the effect of dead space around the wounds could minimize the risk of bleeding complications. A multicentric study or case accumulation is needed to further evaluate the risk factors of removal pectus bar(s).

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“…The minimally invasive repair of pectus excavatum, also known as the Nuss procedure, has become the procedure of choice for children, adolescents, and even adults who require surgical correction for pectus excavatum. 1,2 Severe postoperative pain is the most common complaint after the Nuss procedure, especially in adult patients whose chest wall is more rigid than younger patients. [3][4][5] Prolonged hospitalization for severe pain could further lead to increased medical expenses.…”

Section: Introductionmentioning

confidence: 99%

Extended pain relief achieved by analgesic-eluting biodegradable nanofibers in the Nuss procedure: in vitro and in vivo studies

Liu

Chen

Lee

et al. 2018

IJN

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BackgroundThe most common complaint after the Nuss procedure is severe postoperative chest pain. The aim of this study was to evaluate the effectiveness of analgesic-eluting biodegradable nanofibers in pain relief after the Nuss procedure.Materials and methodsPoly(d,l)-lactide-co-glycolide, lidocaine, and ketorolac were dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. This solution was electrospun into a nanofibrous membrane. The elution method and high-performance chromatography were used to characterize the in vitro drug release. Stainless steel bars with and without coating of the analgesic-eluting nanofibrous membrane were implanted underneath the sternums of New Zealand white rabbits. The in vivo characteristics were further investigated.ResultsThe in vitro study showed that the biodegradable nanofibers released high doses of lidocaine and ketorolac within 10 days. The in vivo study demonstrated high local and systemic concentrations of lidocaine and ketorolac. The serum creatinine level was unaffected. Animals that received implants of the analgesic-eluting nanofiber-coated stainless steel bar exhibited significantly greater food and water ingestion and physical activity than the control group did, indicating effective pain relief.ConclusionThe proposed analgesic-eluting biodegradable nanofibers contribute to the achievement of extended pain relief after the Nuss procedure, without obvious adverse effects, in an animal model.

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Early and Late Results of the Nuss Procedure in Surgical Treatment of Pectus Excavatum in Different Age Groups

Cited by 63 publications

References 28 publications

Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum

Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum

Minimization of the complications associated with bar removal after the Nuss procedure in adults

Extended pain relief achieved by analgesic-eluting biodegradable nanofibers in the Nuss procedure: in vitro and in vivo studies

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