Minimally Invasive Repair for Pectus Excavatum in Adults

Teh, Swee H.; Hanna, Angela M.; Pham, Tuan H.; Lee, Adriana; Deschamps, Claude; Stavlo, Penny; Moir, Christopher R.

doi:10.1016/j.athoracsur.2008.03.011

Cited by 26 publications

(23 citation statements)

References 13 publications

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“…Perhaps their small patient cohort contributed to this elevated complication rate. We only found comparable adult complication rates this high in other small cohort (n < 20) studies [32,36,41]. Another confounder may be surgical experience.…”

Section: Reviewcontrasting

confidence: 56%

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

Johnson

Fedor

Singhal

2014

J Cardiothorac Surg

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This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric = 0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation.

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Section: Reviewcontrasting

confidence: 56%

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

Johnson

Fedor

Singhal

2014

J Cardiothorac Surg

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“…Our initial results indicate that, similar to scoliosis bracing, treatment during the pubertal growth spurt may yield the best outcomes. It is well known that repair of PE deformities in postpubertal patients is increasingly difficult as the malformed cartilages ossify and the chest wall stabilizes [14][15][16][17]. From our limited experience thus far, we believe that this technique will be best applied to those patients who are entering the rapid growth spurts of puberty as determined from a simple xray of the wrist using a modified Tanner-Whitehouse III index [18].…”

Section: Discussionmentioning

confidence: 93%

Magnetic Mini-Mover Procedure for pectus excavatum

Harrison

Curran

Jamshidi

et al. 2010

Journal of Pediatric Surgery

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“…The surgical treatment of pectus excavatum has changed considerably in the last several decades, ranging from the open repair to the recently described minimally invasive technique known as the Nuss procedure. 19 Extensive data exist on the use of the Ravitch repair in adult patients, but there is an increasing trend toward using the minimally invasive approach to repair these defects in older population. 20 The Ravitch operation has provided the best long-term results with the least discomfort and fewest complications for treatment of pectus excavatum, and thus, the procedure has been the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

“…9 Nuss and colleagues 7 also note that bar displacement occurs in 15% of patients without a stabilizer, in 6% of patients with a stabilizer but without wiring, and in only 5% of patients with wiring of the stabilizer. 19 Therefore, stabilizing techniques used in adults must be reinforced with wiring of the stabilizer.…”

Section: Discussionmentioning

confidence: 99%

Pectus Excavatum: A Comparison of the Ravitch Repair with the Nuss Thoracoscopic Technique with a Standard Metal Bar or an Absorbable Bar

Muhammad

2013

Innovations�(Phila)

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Objective Although pectus excavatum repair has evolved to a minimally invasive technique in prepubescent patients, the best approach in adults is less clearly understood. The aim of this study was to identify the preoperative characteristics, operative variables, and postoperative outcomes in adult patients with pectus excavatum undergoing thoracoscopic repair using different bar stabilizers compared with the open surgical repair. Methods We conducted a prospective study between July 2009 and July 2012 in a single institution. Thirty-one patients (26 men and 5 women) aged 18 to 35 years were randomly assigned into three groups: group A, 9 patients underwent modified Ravitch repair; group B, 11 patients underwent video-assisted thoracoscopic repair using metal stabilizers; and group C, 11 patients underwent video-assisted thoracoscopic repair using absorbable stabilizers. Preoperative, intraoperative, and postoperative variables are compared between all groups. Results In all groups, the preoperative variables were well matched for age, sex, and Haller index. Operative time was 2 hours longer in group A (P = 0.0001). There was no intraoperative complication. Length of hospital stay was 4 days shorter in group A. Morbidity was 23% and composed of pneumothorax (three), wound seroma (two), pleural effusion (one), and stabilizer break (one), occurring more frequently in groups B and C. There was no perioperative mortality. All patients were satisfied with the cosmetic results. Conclusions Repair of pectus excavatum in adult patients can be performed effectively through either open surgical technique or thoracoscopy, with no intraoperative complications and with excellent immediate results. Although the operative time for the Ravitch repair was longer, the hospital stay was significantly shorter than that for the video-assisted method.

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Minimally Invasive Repair for Pectus Excavatum in Adults

Cited by 26 publications

References 13 publications

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

Magnetic Mini-Mover Procedure for pectus excavatum

Pectus Excavatum: A Comparison of the Ravitch Repair with the Nuss Thoracoscopic Technique with a Standard Metal Bar or an Absorbable Bar

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