Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum

Cheng, Yeung-Leung; Lee, Shih-Chun; Huang, Tsai-Wang; Wu, Ching-Tang

doi:10.1016/j.ejcts.2008.07.068

Cited by 60 publications

(83 citation statements)

References 21 publications

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“…The indications for surgical repair were 2 or more of the following criteria demonstrated by Dr. Nuss: (1) progression of the deformity; (2) exercise intolerance; (3) progressive chest pain or dyspnea; (4) restrictive ventilatory impairment; (5) Haller index >3.25; (6) cardiac compression (7) mitral valve prolapsed. 9,10) The demographic data, clinical data, complications, and surgical outcome were collected. This study was approved by the Ethics Committee and the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC (TSGH-IRB No: 098-05-244).…”

Section: Methodsmentioning

confidence: 99%

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Pleural Effusion Complicating after Nuss Procedure for Pectus Excavatum

Cheng

Lin

Wang

et al. 2014

Ann Thorac Cardiovasc Surg

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Purpose: The Nuss procedure is a minimally invasive method for the correction of pectus excavatum (PE). Pleural effusion complicating following the Nuss procedure was uncommon but may be critical. We evaluated the risk factors of postoperative pleural effusion after Nuss repair. Methods: We included all patients with PE primarily corrected by Nuss procedure from July 2005 to December 2011. The clinical features, treatment and outcomes of these patients with pleural effusion were analyzed retrospectively. Results: 390 patients (338 men, 52 women) with a mean age of 23.9 years (5-44 years) were included. Postoperative pleural effusion occurred in 10 patients (2.6%). The time of occurrence of pleural effusion was on a mean of 16.6 days (8-32 days) after operation presenting with progressive dyspnea. All of these patients were adults, and 9 patients (90%) were repaired by two pectus bars (p <0.001). Six patients with massive pleural effusion received thoracocentesis (400 ml-1000 ml). All of the effusions were exudative. These patients took short-term indomethacin or steroids without removal of bars and all recovered well after a mean of 40 months (12-72 months) follow-up. Conclusions: Pleural effusion complicating after Nuss procedure was uncommon. It occurred most on adult patients with placement of double bars. Close follow-up in adults after more than one bar insertion is recommended. Administration of temporary medications of indomethacin/steroid and/or thoracocentesis could obtain a satisfying result. Early administration of indomethacin/steroid in adult patients repaired by two bars with mild pleural effusion for preventing pooling of effusion could also be considered.

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Section: Methodsmentioning

confidence: 99%

“…10) In brief, all patients had a thoracic epidural for intraoperative anesthesia and postoperative pain control. The patient was placed in the supine position after general anesthesia.…”

Section: Surgical Preparation and Techniquementioning

confidence: 99%

Pleural Effusion Complicating after Nuss Procedure for Pectus Excavatum

Cheng

Lin

Wang

et al. 2014

Ann Thorac Cardiovasc Surg

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“…In the remaining 4, conservative treatment such as drainage, pleural puncture or blood transfusion was sufficient. In our opinion, the use of videothoracoscopy plays an important role in prevention of serious complications, as was previously pointed out by other authors [9,19]. Acquiring more experience in Nuss procedures over the years, we are of the opinion that the use of bilateral VATS makes this procedure more safe, preventing potential injuries to the heart and vessels.…”

Section: Discussionmentioning

confidence: 66%

“…We analyzed the results of treatment in a large group of 622 patients operated on in one institution. This enabled us to evalu- ate the whole process -from the moment of diagnosis to the final, long-term results [4,5,9]. One of the conditions for effective treatment of congenital deformities of the chest is the proper choice of time for surgery.…”

Section: Discussionmentioning

confidence: 99%

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Thoracic surgery Early and late results of the Nuss operation for pectus excavatum – a single institution experience

Pawlak¹,

Zieliński²,

Gabryel³

et al. 2013

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StreszczenieWstęp: Obecnie małoinwazyjna metoda Nussa jest powszechnie uznanym sposobem chirurgicznego leczenia klatki piersiowej lejkowatej. Celem pracy była ocena wyników leczenia operacyjnego klatki piersiowej lejkowatej metodą Nussa, ze szczególnym uwzględ-nieniem stosowanej techniki chirurgicznej. Materiał i metody: Od 2002 r. do 2010 r. u 622 pacjentów (średnia wieku 18,2 roku) wykonano zabieg operacyjny metodą Nussa z powodu klatki piersiowej lejkowatej. Jedną płytkę korekcyjną wszczepiono u 317 pacjentów, dwie płytki u 296, a trzy u pozostałych 9 pacjentów. Implanty usuwano po 2,5-3 latach. Wyniki: Dobre i bardzo dobre wyniki korekcji metodą Nussa uzyskano u 593 (95,3%) pacjentów. Nie obserwowano zgonów we wczesnym okresie pooperacyjnym. Przemijające i niegroź-ne dla życia powikłania wystąpiły w 213 (34,24%) przypadkach -najczęściej była to odma i płyn w opłucnej (22,5%). Asymetryczne i złożone deformacje klatki piersiowej lejkowatej, reoperacja po uprzednio wykonanym zabiegu korekcyjnym, czas operacji powyżej 60 min, wiek powyżej 18 lat, wszczepiona więcej niż jedna płytka korekcyjna oraz płeć męska miały znaczący wpływ na występowanie powikłań w okresie pooperacyjnym. Wnioski: 1. Małoinwazyjna metoda Nussa zapewnia bardzo dobre i dłu-gotrwałe wyniki w leczeniu klatki piersiowej lejkowatej. 2. Kontrola wideotorakoskopowa podczas implantacji płytek korekcyjnych może zapobiec ewentualnemu uszkodzeniu narządów śródpiersia. 3. U pacjentów poniżej 18. roku życia liczba powikłań jest znacznie niższa (p = 0,0025). Słowa kluczowe: klatka lejkowata, operacja Nussa, powikłania pooperacyjne. THORACIC SURGERY AbstractObjective: The purpose of this study was to evaluate the results of operative treatment of pectus excavatum using the Nuss method, with particular emphasis on the surgical technique used. Material and methods: Between 2002 and 2010, 622 patients (mean age 18.2) underwent surgical correction for pectus excavatum. One Nuss bar was implanted in 317 patients, two plates in 296, and 3 in the remaining nine patients. Metal bars were removed after 2.5-3 years. Results: Good and very good corrective effect of the Nuss procedure was achieved in 593 (95.3%) patients. There was no mortality in the early postoperative period. Transient and minor complications occurred in 213 (34.24%) patients -the most frequent were pneumothorax and pleural effusion (22,5%). An asymmetric funnel chest deformity, a complex deformity, reoperation after previously performed corrective surgery, operative time exceeding 60 min, age above 18 years, more than one implanted corrective plate and gender had significant influences on the occurrence of complications in the postoperative period. Conclusions: 1. The Nuss minimal invasive procedure is very effective and provides very good long-term results in the treatment of pectus excavatum. 2. The use of video-thoracoscopic control during insertion of implanted bars may prevent potential damage to the mediastinal organs. 3. In patients below 18 years old the number of postoperative complicati...

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