Minor and Major Complications Related to Minimally Invasive Repair of Pectus Excavatum

Abstract

The technique for minimally invasive repair of pectus excavatum (MIRPE) has been adopted by most surgeons as the preferred method for treatment of this condition. However, there is limited awareness about the complications related to the procedure. Most importantly, the prevalence and potential for life-threatening complications have frequently been underestimated. The purpose of this communication is to increase awareness of the risk of minor and major (life-threatening) complications, as well as the operative steps and modifications which have been developed to prevent them. One of the most common complications reported in the early series of MIRPE cases was bar displacement, frequently requiring reoperation. Fortunately, technical modifications to the technique have resulted in a decrease in the incidence of such events from 10 to less than 2%. It is important for surgeons to have a good understanding of the potential complications, particularly the major type of complications post-MIRPE and postpectus bar removal. Although rare, the risk of mortality is real and it is the surgeon's responsibility to ensure optimal patient safety when performing this procedure. Factors such as operative technique, patient age, pectus severity and asymmetry, previous chest surgery, and the surgeon's experience play a role in the overall incidence of adverse events. These preventable events can be avoided with proper training, mentoring, and careful patient selection.

Aktuelle Behandlung der Trichterbrust und Kielbrust

“…In erfahrenen Händen gilt die MIRPE als sicher und effektiv. Operative Risiken für eine kardiale Verletzung, massive Blutun gen und Tod sind real und sollten im Rahmen der präoperativen Aufklärung ehrlich mit den Patienten und Eltern besprochen wer den, auch wenn diese "majorcomplications" sehr selten sind (< 0,1 %) [29].…”

“…Allenfalls KontaktSportarten sollten bis zur Implantatentfernung nach 3 Jahren vermieden werden. Die analge tische Therapie mit nichtsteroidalen Antirheumatika sollte nach 3-4 Wochen beendet werden, um mögliche gastrointestinale Ne benwirkunen zu vermeiden[29].…”

The Quality of Web Sites' Health Information on Minimal Invasive Repair of Pectus Excavatum Using the DISCERN Instrument

“…And there is no focus on patient-reported outcomes or complications. 12,13 One of the criteria that determine the value of healthrelated information on the Internet is the competency of patients to critically assess the provided information. Are they capable of differentiating between low and high quality Web sites, can they recognize bias in the information?…”

The use of lung ultrasound compared to chest X‐ray to diagnose pneumothorax following the Nuss procedure for pectus excavatum repair in children

“…Residual pneumothorax at the end of the procedure is reported to occur in 5%‐50% of cases. However, the clinical significance of pneumothorax is irrelevant in many cases and does not necessitate any intervention 2‐4 . The gold standard for the diagnosis of pneumothorax is computed tomography (CT) 5 ; however, this should ideally be avoided in cases of not clinically significant pneumothorax, especially in the pediatric population, in order to minimize patient exposure to X‐ray radiation 6 .…”

“…and does not necessitate any intervention. [2][3][4] The gold standard for the diagnosis of pneumothorax is computed tomography (CT) 5 ; however, this should ideally be avoided in cases of not clinically significant pneumothorax, especially in the pediatric population, in order to minimize patient exposure to X-ray radiation. 6 In our institute, it is routine practice to evaluate the presence of pneumothorax by means of a chest X-ray examination at the end of the surgery before the patient awakes from general anesthesia.…”