TECHNOLOGY OF MINIMALLY INVASIVE SURGICAL CORRECTION FUNNEL-SHAPED DEFORMATION OF THE CHEST IN CHILDREN

Abstract

The most common method surgical treatment of pectus excavatum (PE) is thoracoplasty according by D.Nuss at the moment. But serious complications associated with trauma to the pericardium, blood vessels, and bleeding are known. Objective. Development of a modified technology surgical correction of pectus excavatum, which involves exclusively extrapleural passage of the plate, according to the individual size and shape of the deformation of the patient’s chest, in order to prevent intraoperative complications. Methods. 81 patients aged 10 to 17 years were involved in the study. A modified technology of extrapleural surgical correction of PE was performed. The plate was carried level of the VI–VII sternocostal joints through the formed through submuscular-extrapleural retrosternal tunnel from right to left under control of right-sided thoracoscopy. The plate was modeled according by individual deformation parameters chest. The analysis was carried out according to the following criteria: age, gender, type of deformity, Haller index, duration of surgery, intraoperative and early postoperative complications according by Clavien–Dindo classification. Results. The median age of patients was (13.8 ± 1.9) years, of which there were 65 (85.25 %) boys, 16 (19.75 %) girls. 48 (59.3 %) children were diagnosed with type I (symmetric) deformity, and 33 (40.7 %) with type II (asymmetric) according to the classification. The median Haller was (4.07 ± 0.62), which corresponds to 2–3 degrees. Differences in the degree of deformation in children of different sexes were not determined (р = 0.828). Impaired lung function was d iagnosed i n 55.55 % (n = 45), i mpaired h eart f unction — 40.74 % (n = 33). T he d uration of the o peration was on a verage (70.6 ± 15.4) minutes, from 50 to 110 minutes. Early postoperative complications were found in 5 (6.17 %) patients classified as grade I (mild) according to the Clavien–Dindo classification, which did not require additional medical or surgical correction. After the operation, the correction of chest deformation was on average (2.35 ± 0.22) according by Haller index, which was statistically significantly (р = 0.001) different from the initial level. Conclusions. The use of modified technology surgical correction of PE meets safety requirements and minimizes postoperative complications.