Management of deep pectus excavatum (DPE)

Campos, José Ribas Milanez de; Tedde, Miguel Lia

doi:10.21037/acs.2016.09.02

Cited by 7 publications

(16 citation statements)

References 21 publications

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“…Being discreetly depressed in its central portion, it avoids hypercorrection and exposure of the xiphoid process until its withdrawal. 3 These modifications introduced in the molding and positioning of the bar (mainly when there is only one) as well as its stabilizers help in improving the aesthetical results. The last surgical step (the resection of the xiphoid process by the anterior route through the skin) has also been described.…”

Section: Discussionmentioning

confidence: 99%

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Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum

Anger

Campos

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Since 1994, we have used soft silicone blocks sculpted intraoperatively to correct pectus excavatum in male patients. This technique involves a horizontal access incision in the region of the lower edge of the sternum. During the dissection to expose the sternum, we observed a constant diastasis of the rectus abdominis muscle and changes of the anatomy at its superior insertion. There is no report on this association. Methods: Male patients with untreated medial pectus excavatum with indication for silicone block correction were enrolled. Age, weight, height, and the presence of other associated conditions were noted. Ultrasound examination was performed. During the surgery, the width of the linea alba was evaluated and the anatomical positioning of the insertion of rectus abdominis muscle was noted. Results: From 2017 to 2019, 10 patients were submitted to surgery. The mean age was 27 years. All patients presented diastasis at the preoperative physical examination. Imaging examination reports showed diastasis of the rectus abdominis muscle: seven partial epigastric separations and three total separations, two of which were associated with umbilical hernia. The intraoperative findings showed the line alba with a minimum of 23 mm and a maximum of 45 mm width at 4 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches with a distance ranging from 35 mm to 60 mm. Conclusions: This study confirms the anatomical alterations of the superior portion of the rectus abdominis muscle. The authors discuss the surgical consequences and suggest that the semiology of rectus abdominis muscle is an important preoperative action in pectus excavatum patients.

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Section: Discussionmentioning

confidence: 99%

“…This may facilitate the correction and conceals the space left by the RAM diastasis better; however, it must be better evaluated. 3 …”

Section: Discussionmentioning

confidence: 99%

Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum

Anger

Campos

2022

Plastic and Reconstructive Surgery - Global Open

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“… 17 Nowadays, there are different tools that can be used for this purpose: vacuum bell, Uemura hooks, Dr. Park's Crane, Rultract retractor, among others. 5 18 de Campos and Tedde 18 describe several techniques that have allowed the upward traction of the sternum to make the repair safer. These procedures may be used not only in the case of severe PE but also in mild or moderate PE.…”

Section: Discussionmentioning

confidence: 99%

Nuss Procedure for a Patient with Negative Haller Index

Dore

Junco

Torre

et al. 2018

European J Pediatr Surg Rep

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Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed. All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.

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“…Ідея інтраопераційної елевації грудини для безпечного маніпулювання в загрудинно-му просторі та вільного проведення пластини та її розвороту знайшла чимало прихильників. Із цією метою використовуються такі прилади та інструменти, як вакуумний дзвін (Vacuum Bell), [19], однозубі гачки Kocher або Uemura [3,14]; «підйомний кран» Парка (за цієї методики прошивають стальною лігатурою нижню третину грудини, піднімають у скориговане положення і фіксують до гачка, розташованого над операційним столом безпосередньо над найглибшою точкою деформації [15,16]; «Rultract Sky Hook Retractor System» [3]; методика підйому передньої грудної стінки гачками Кохера через основні бокові доступи, розташовані медіальніше, ніж при класичній методиці [3]. Існує метод підтягнення грудини за вкручений у середину тіла грудини «кістковий» кортикальний гвинт [3].…”

Section: оригінальні дослідження торакальна хірургіяunclassified

“…Із цією метою використовуються такі прилади та інструменти, як вакуумний дзвін (Vacuum Bell), [19], однозубі гачки Kocher або Uemura [3,14]; «підйомний кран» Парка (за цієї методики прошивають стальною лігатурою нижню третину грудини, піднімають у скориговане положення і фіксують до гачка, розташованого над операційним столом безпосередньо над найглибшою точкою деформації [15,16]; «Rultract Sky Hook Retractor System» [3]; методика підйому передньої грудної стінки гачками Кохера через основні бокові доступи, розташовані медіальніше, ніж при класичній методиці [3]. Існує метод підтягнення грудини за вкручений у середину тіла грудини «кістковий» кортикальний гвинт [3]. Більшість із запропонованих методів мають певні недоліки: вакуумний дзвін закриває операційне поле, недієвий при тяжких асиметричних ригідних деформаціях, «Rultract Sky Hook Retractor System» частково перекриває операційне поле асистенту, обмежуючи його ергономічність; підняття передньої грудної стінки гачками за ребра недостатньо ефективне та виключає з іншої роботи асистентів; «підйомний кран» Park не передбачає можливості поступово піднімати грудну стінку.…”

Section: оригінальні дослідження торакальна хірургіяunclassified

Nuss surgery: ways to reduce the frequency of postoperative complications, severity and duration of postoperative pain

Zaremba¹,

Danylov²

2021

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Funnel chest deformity is the most common malformation of the anterior chest wall, which in many cases leads to cardiorespiratory disorders and psychological problems. The undisputed progress in her treatment is the Nuss procedure, which is the «gold standard». However, this surgical operation and its modifications carry potential risks of severe postoperative and intraoperati. The aim is analyzation the existing variants of Nuss procedure and developing our own modification of this kind of surgery to eliminate intraoperative risks, reduce the level of postoperative complications, minimize postoperative pain. Materials and methods. In 2018–2019, the authors operated on 34 patients with funnel chest (Nuss operation in its own modification) with II and III degrees of deformity. The analysis of postoperative complications, the level of postoperative pain on the NRSP scale up to 3 months after surgery; duration of interventions, volume of intraoperative bleeding are made. Features of the proposed modification of the operation are: 1) Using of a monolithic T-shaped titanium bar with a removable stabilizer; 2) Formation of the tunnel is strictly under the muscles; 3) Rigid subperiostal fixation of bar stabilizers to two ribs on each side; 4) Using bars of different width for different age categories; 5) As a device for gradual dosed intraoperative lifting of the sternum used a turnbuckle; 6) The working port is entered through the right main access and through the right subpectoral tunnel; 7) Correction of asymmetric forms of deformation is carried out due to asymmetric rigid fixation of stabilizers and traction of the sternum by several ligaturesve complications. Results. The proposed modification of the Nuss operation reduces intra- and postoperative risks: only one postoperative complication was registered (2.9%); the method fixation of bar avoids the risks of eruption, displacement and reversal of the bar (no case has been registered), significantly reduces postoperative pain and prevents its chronicity. In all cases of correction of asymmetric forms of deformation it was possible to achieve good aesthetic results with the installation of one fixing bar. Conclusions. Gradual traction of the sternum to the position of moderate hypercorrection eliminates the risk of manipulation in the retrosternal space; subperiostal fixation of the bar to two ribs on each side guarantees reliable fixation of the plate without the risk of its displacement and reversal. Smaller bar thickness and width; fixing it as an arched structure reduces injuries of intercostal vascular nerve bundles and ribs and reduces postoperative pain. Placing the working port at the point of exit of the bar from the right pleural cavity facilitates and ensures manipulation in the mediastinum, providing sufficient elevation of the sternum. When using the proposed modification in most cases, it is sufficient to install one correction bar. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: Nuss procedure, funnel chest, postoperative complications, postoperative pain syndrome, intraoperative lifting of sternum, turn-buckle, fixation of bar, thoracoscopy.

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Management of deep pectus excavatum (DPE)

Cited by 7 publications

References 21 publications

Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum

Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum

Nuss Procedure for a Patient with Negative Haller Index

Nuss surgery: ways to reduce the frequency of postoperative complications, severity and duration of postoperative pain

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