Abstract
BackgroundPectus 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.MethodsConsecutive 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.ResultsA 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).ConclusionsAdult 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).
Highlights
Pectus bar removal after Nuss repair is associated with the risk of major complications that are underreported
Pectus excavatum (PE) is the most common congenital chest wall deformity; it is characterized by a caved-in appearance of the anterior chest [1]
After the ends of the bar were exposed, the right end of the bar was partially straightened by the pectus removal bender (Zimmer Biomet, Jacksonville, FL, USA). Participants This retrospective study was approved by the Ethics Committee and the Institutional Review Board (IRB) of Postoperative care A portable chest radiograph was taken at bedside after the operation
Summary
Pectus bar removal after Nuss repair is associated with the risk of major complications that are underreported. Old age and placement of more than one bar are reported risk factors for pectus bar removal. We presented our experience regarding the modified skills required to minimize complications during bar removal, especially in adult patients. The incidence rate is approximately 0.1% with a male to female ratio of 4:1. It is associated with connective tissue disorders, neuromuscular diseases, and some genetic conditions [1, 2]. In 1998, Nuss and colleagues documented the minimally invasive repair of pectus excavatum (MIRPE), known as the Nuss procedure, a minimally invasive method for the correction of PE [3]. 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]
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