Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice?

Erşen, Ezel; Demirkaya, Ahmet; Kılıç, Burcu; Kara, Hasan; Yakşi, Osman; Alizade, Nurlan; Demirhan, Özkan; Sayılgan, Cem; Turna, Akif; Kaynak, Kamil

doi:10.5114/wiitm.2016.60456

Cited by 19 publications

(21 citation statements)

References 25 publications

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“…Despite the routine use of thoracoscopy, cardiac perforation [ 7 – 9 , 16 , 17 ], pericardial tear [ 14 ], pericardial tamponade [ 4 , 18 , 19 ], lung injury [ 20 ], diaphragmatic liver piercing injury [ 6 , 15 , 21 ], vena cava inferior occlusion [ 22 , 23 ] and internal thoracic artery disruption have been observed [ 24 ]. Castellani et al and Erşen et al successfully repaired intraoperative heart injury by urgent thoracotomy [ 16 , 17 ], On the other hand, 3 cases of early postoperative death due to cardiac perforation during the Nuss procedure have been reported so far [ 7 – 9 ]. Although most of the life-threatening complications are diagnosed intraoperatively or in the early postoperative period; some of them may also develop later, even many weeks or months after surgery [ 4 , 18 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

Pawlak

Gąsiorowski

Gabryel

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionAdditional use of the video-assisted thoracoscopic surgery (VATS) technique in the Nuss procedure has been globally accepted for the improvement of safety of surgical treatment as well as for decreased frequency of serious intraoperative and postoperative complications.AimTo evaluate VATS in surgical treatment of patients with pectus excavatum by the left-to-right Nuss procedure for prevention of serious intra- and postoperative complications.Material and methodsFrom 2002 to 2016, 1006 patients with pectus excavatum aged 7 to 62 years (mean: 18.6) underwent the Nuss procedure. There were 796 males and 210 females. The clinical records of all patients were analyzed retrospectively. The follow-up varied from 1 to 172 months (mean: 80.7 ±43).ResultsThe early 30-day postoperative mortality was zero. Early thoracoscopy-dependent postoperative complications, the majority transient and non-life-threatening, occurred in 35.6% of patients. The most frequent complication was pneumothorax, diagnosed in 24.5% of patients. Two patients required repeat surgery. One patient required VATS pleurectomy due to persistent postoperative air leakage. In another patient left thoracotomy following bleeding from the pleural cavity was performed.ConclusionsThe use of VATS in the left-to-right Nuss procedure for pectus excavatum ensures the safety of surgical treatment and minimizes the occurrence of serious intra- and postoperative complications concerning injury of the mediastinum, lung, diaphragm or abdominal cavity.

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Section: Discussionmentioning

confidence: 99%

Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

Pawlak

Gąsiorowski

Gabryel

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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“…Repair of PE in adults can be more difficult and is associated with a greater number of complications and a higher incidence of repair failures [6][7][8][9][10][11][12][13][14]. Most literature about failed MIRPE procedures or recurrent PE has reported malpositioned or displaced bars as the most common causes [17,18,28].…”

Section: Commentmentioning

confidence: 99%

“…The Nuss procedure or minimally invasive repair of pectus excavatum (MIRPE) is the most common surgical repair used for pediatric and adolescent PE patients [2][3][4][5]. Extending the MIRPE technique for PE repair in adults, which is more difficult, has been reported to result in higher complications and repair failures [6][7][8][9][10][11][12][13][14]. These MIRPE failures have been related to technical issues, with the most common being pectus support bar rotation, posterior-lateral bar migration due to intercostal muscle stripping, and failure of the chest wall to elevate due to excessive rigidity and calcification ( Fig 1A to 1D) [15][16][17][18][19][20][21][22][23][24].…”

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confidence: 99%

Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum

Ashfaq

Beamer

Ewais

et al. 2018

The Annals of Thoracic Surgery

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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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Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice?

Cited by 19 publications

References 25 publications

Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum

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

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