Treatment Of Pectus Excavatum Research Articles

A student's perspective on surgical specialty education in Turkiye

Pediatric surgery is defined as the diagnostic, operative, and postoperative surgical care of children with developmental, inflammatory, neoplastic, traumatic congenital, and acquired anomalies and diseases. A pediatric surgeon can perform many surgeries such as; appendectomy, colectomy, cholecystectomy, splenic splenectomy, inguinal and umbilical hernia, pectus excavatum treatment. Subspecialties of pediatric surgery mainly include: neonatal surgery and fetal surgery, some of the pediatric cardiothoracic procedures, pediatric nephrological surgery, pediatric neurosurgery, and some procedures that may be related to pediatric urological surgery (surgery related to the child's kidneys and ureters, including kidney or kidney transplantation, surgery of the child's urinary bladder and other structures and the lower part of the kidney required for ejaculation), pediatric emergency surgery, surgery involving fetuses or embryos (overlapping with obstetric/gynecological surgery, neonatology, and maternal-fetal medicine), surgery involving adolescents or young adults, pediatric hepatological (liver) and gastrointestinal (stomach) surgery (including liver and intestinal transplantation in children), some pediatric orthopedic surgeries, pediatric plastic and reconstructive surgery, and pediatric oncological (childhood cancer) surgery. We evaluate the statual level of education in schools of medicine

Treatment of pectus excavatum in children with the vacuum bell: a literature review

Treatment of pectus excavatum in children with the vacuum bell: a literature review

Sternal cleft and pectus excavatum: an overlooked congenital association?

Sternal cleft (SC), a rare thoracic malformation, is associated with pectus excavatum (PE) in 2.6-5% of cases. It remains unclear if these conditions are congenitally linked or if SC repair triggers PE. To investigate the potential higher frequency of PE in SC cases, we conducted a retrospective study of our SC patients. We assessed PE incidence, progression, and management in SC patients treated at our institute from 2006 to 2022. When available, we collected pre-SC repair CT scan data, calculating the Haller Index (HI) and Correction Index (CI) and compared them to a selected control group. Among 8 SC patients, 7 had concomitant PE (87.5%), varying in severity. PE management ranged from observation to thoracoplasty, depending on its degree. We observed a significant pre-operative CI difference between SC and control group patients (p < 0.00001). In the last two SC repair cases, we attempted concurrent PE prevention or treatment. Our findings suggest an underestimated association between PE and SC in the existing literature. SC patients may exhibit a predisposition to PE from birth, which may become more apparent with growth after SC repair. Consequently, PE prevention or treatment should be considered during SC repair procedures.

Pectus excavatum. Tratamiento quirúrgico: ¿estructural o estético?

IntroductionPectus excavatum is a wall deformity that often warrants medical evaluation. In most cases, it's a purely visual aesthetic alteration, while in others, it comes with symptoms. Several surgical techniques have been described, but their outcomes are difficult to assess due to the heterogeneity of presentations and the lack of long-term follow-up. We present our experience as thoracic surgeons, assessing correction as either structural (remodeling of the thoracic cage through open surgery) or aesthetic (design and implantation of a customized 3D prosthesis). Material and methodsRetrospective observational study of the indication for surgical treatment of pectus excavatum carried out by a team of thoracic surgeons and the short- to mid-term results. ResultsBetween 2021 and 2023, we treated 36 cases surgically, either through thoracic cage remodeling techniques or with 3D prostheses. There were few minor complications, and the short- to mid-term results were positive: alleviation of symptoms or compression of structures when present, or aesthetic correction of the defect in other cases. ConclusionsSurgery for pectus excavatum should be evaluated for structural correction of the wall or aesthetics. In the former, thoracic cage remodeling requiring cartilage excision and possibly osteotomies is necessary. In the latter, the defect is corrected with a customized 3D prosthesis.

Використання вакуумного коректора для лікування лійкоподібної деформації грудної клітки в дітей молодшої групи: динаміка змін ехокардіографії

Pectus excavatum (PE) si common disease among children, which in most cases manifests during the period of intensive growth. Children with PE may have asymptomatic changes in the heart and may not cause concern for some time. Purpose - to evaluate of the dynamics of echocardiography changes during conservative treatment of PE by vacuum bell therapy. Materials and methods. An evaluation of 28 patients with an average age of 6.4±1.2, who underwent conservative treatment of PE, was carried out. Cardiac ultrasound data before and after treatment were processed statistically. Results. After treatment, signs of mitral valve prolapse in children remained, that is, there were no qualitative changes. But the overall level of prolapse decreased statistically significantly (p=0.042) from 1.97±0.87 mmHg. to 1.73±0.69 mm Hg. Paradoxical movement of the interventricular membrane was not a frequent defect and before treatment was observed only in 5 (17.9%) children. After treatment, this defect was not noted. Myocardial function in all children was normal (&gt;60%) both before treatment (69.86±8.21%) and after (68.54±2.67%). Conclusions. In pediatric population disturbances in the work of the heart with PE are often in a compensated or subcompensated state, but in the future they can lead to functional disorders.Screening use of echocardiography is recommended for all children with manifestations of funnel-shaped chest deformity. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Peer Mentorship Enhances Coping in Children, Adolescents, and Young Adults with Pectus Excavatum and Adolescent Idiopathic Scoliosis

Purpose: Children and adolescents and young adults (AYA) with pectus excavatum (PE) and adolescent idiopathic scoliosis (AIS) experience similar journeys regarding pain, body image, and self- and peer acceptance. Peer mentoring may address some of the challenges faced regarding diagnosis and treatment of PE and AIS. Before implementing a mentor program, our hospital noted an increased length of stay (LOS) and difficulty coping in those undergoing surgery for PE and AIS, emphasizing the need for additional support. The purpose of this study was to evaluate the impact of a peer mentor program for children/AYAs with PE or AIS and their parents on coping, pain, and LOS. Design and Methods: This non-randomized controlled trial included a prospective intervention group that received peer mentorship and a retrospective control group that received standard care. Self-reported surveys assessed the effect of the mentor program on coping. Qualitative data on coping were analyzed descriptively. Postoperative pain and LOS were obtained from the health record. Bivariate inferential statistics were used to compare the distribution of pain scores and LOS between intervention and control groups. Results: Children/AYAs, parents, and mentors reported enhanced coping and found peer mentorship beneficial, though it did not have a statistically significant impact on pain or LOS. Conclusions: Peer mentorship facilitates coping in children/AYAs with PE or AIS undergoing corrective surgery. Parents and mentors also perceived benefits. Practice Implications: Pediatric nurses and child life specialists can help children/AYAs, and their families prepare for surgery by connecting them with peer mentors and social support.

Pectus excavatum. Surgical treatment: Structural or aesthetic?

IntroductionPectus excavatum is a wall deformity that often warrants medical evaluation. In most cases, it’s a purely visual aesthetic alteration, while in others, it comes with symptoms. Several surgical techniques have been described, but their outcomes are difficult to assess due to the heterogeneity of presentations and the lack of long-term follow-up. We present our experience as thoracic surgeons, assessing correction as either structural (remodeling of the thoracic cage through open surgery) or aesthetic (design and implantation of a customized 3D prosthesis). Material and methodsRetrospective observational study of the indication for surgical treatment of pectus excavatum carried out by a team of thoracic surgeons and the short- to mid-term results. ResultsBetween 2021 and 2023, we treated 36 cases surgically, either through thoracic cage remodeling techniques or with 3D prostheses. There were few minor complications, and the short- to mid-term results were positive: alleviation of symptoms or compression of structures when present, or aesthetic correction of the defect in other cases. ConclusionsSurgery for pectus excavatum should be evaluated for structural correction of the wall or aesthetics. In the former, thoracic cage remodeling requiring cartilage excision and possibly osteotomies is necessary. In the latter, the defect is corrected with a customized 3D prosthesis.

Complication rates rise with age and Haller index in minimally invasive correction of pectus excavatum: A high-volume, single-center retrospective cohort study

ObjectivesThe study objectives were to describe the compounded complication rate of minimally invasive repair of pectus excavatum, identify predisposing risk factors, and evaluate the optimal timing of correction. Minimally invasive repair of pectus excavatum is the standard treatment for pectus excavatum and consists of 2 invasive procedures, for example, correction with bar insertion followed by bar removal after 2 to 3 years. MethodsA retrospective cohort study identifying children, adolescents, and adults of both genders corrected for pectus excavatum with minimally invasive repair of pectus excavatum between 2001 and 2022. Information on complications related to bar insertion and removal procedures for each individual patient was compiled into a compounded complication rate. Complication severities were categorized according to the Clavien-Dindo classification. ResultsA total of 2013 patients were corrected by minimally invasive repair of pectus excavatum with a median age (interquartile range) for correction of 16.6 (5) years. Overall compounded complication rate occurred at a frequency of 16.4%, of which 9.3% required invasive reinterventions (Clavien-Dindo classification ≥IIIa). The complication rate related to bar insertion was 2.6-fold higher compared with bar removal (11.8% vs 4.5%, respectively). Multivariable analysis revealed age (adjusted odds ratio, 1.05; P < .001), precorrection Haller Index (adjusted odds ratio, 1.10; P < .033), and early-phase institutional experience (adjusted odds ratio, 1.59; P < .002) as independent predisposing risk factors. The optimal age of correction was 12 years, and the compounded complication rate correlated exponentially with age with a doubling time of 7.2 years. Complications increased 2.2-fold when the Haller index increased to 5 or more units. ConclusionsMinimally invasive repair of pectus excavatum is associated with a high compounded complication rate that increases exponentially with age and high Haller Index. Consequently, we recommend repair during late childhood and early adolescence, and emphasize the importance of informing patients and relatives about the significant risks of adult correction as well as the need of 2 consecutive procedures taking the complication profile into account before planning surgery.

Outcomes of the minimally invasive nuss procedure for pectus excavatum

Because of some disadvantages of the "Ravitch method," which is the classical open surgical method used for many years in the treatment of pectus excavatum (PE), as an alternative to it, a minimally invasive surgical method called the “Nuss procedure” has been developed. This procedure has become the most preferred surgical method in the treatment of PE in recent years. In our study, we aimed to share the results of the “Nuss procedure” that we applied to our patients with PE in light of the literature. The files of 77 patients who underwent a Nuss operation for PE in our clinic between July 2007 and March 2023 were evaluated retrospectively. The age, gender, surgical method, complications, and length of hospital stay of the patients were recorded. The median age was 17.71±4.84 years (range, 2.5-33) and the majority of patients were male (63 males, 14 females). As symptoms, 14 (18.2%) patients had dyspnea, 32 (41.5%) had chest pain, and almost all patients had psychosocial problems. While minimal pneumothorax was the most common early postoperative complication (n=18, 23.4%), bar dislocation was the most common late complication (n=5, 6.5%). None of the patients had serious complications such as death, organ injury, or massive bleeding during the operations. We think that the Nuss procedure, which is a minimally invasive approach, can be safely applied to selected patients due to its short operation time, low complication rate, and success in correcting the deformity.

Influence of psychosocial characteristics of patients and opinions of their relatives on indication for surgical treatment of pectus excavatum.

To assess the subjective experience of patients and their parents or relatives about the existing pectus excavatum deformity and to contribute to the definition of indications for surgical treatment of this deformity. The initial sample of psychosocial characteristics consisted of self-assessments and observations of patients (and parents) regarding their health, self-image, health care, possible environmental response to their physical appearance, expectations regarding treatment. A modified version of the original Nuss questionnaire on quality of life was used in the psychological part of the examination. The study included a sample of 58 patients aged 10 to 30 years, and a sample of 58 family members of the patient (parents, relatives). The experience of poor emotional status, withdrawals, and bad self-image in patients older than 15 years than younger were significant. The tendency for female patients to have a worse experience is pronounced and significant. The largest percentage of parents have an 'indecisive' or 'weakly expressed' attitude towards surgery. Parents at a significantly higher rate show greater concern for female children. A systematic evaluation of the psychosocial perception of patients and their relatives (who will consent for the operation) may be a useful diagnostic assessment before correcting an anterior chest wall malformation.

Should There be a Surgical Revision of the Axillary Incisions Prior to a Nuss Bar Extraction?

The minimally invasive Nuss procedure is currently the preferred surgical approach for treatment of pectus excavatum. During this procedure, a retrosternal bar is inserted which instantly corrects the deformity. The bar typically remains in place for 2 to 3 years, during which time the chest is considered to have adopted its new shape. Removal of the bar is generally considered to be a nondemanding procedure. Notwithstanding, it is associated with rare but potentially life-threatening complications.

Combined erector spinae plane block with surgical intercostal nerve cryoablation for Nuss procedure is associated with decreased opioid use and length of stay

Background and objectivesPain management for patients undergoing the Nuss procedure for treatment of pectus excavatum can be challenging. In an effort to improve pain management, our institution added bilateral single...

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

BackgroundDespite advancements in minimally invasive repair of pectus excavatum (MIRPE), Nuss procedure, postoperative pain control remains challenging. This report covers a multimodal regimen using bilateral single-shot paravertebral block (PVB) and bilateral thoracoscopic intercostal nerve (T3–T7) cryoablation, leading to significant reduction in length of stay (LOS) and high rate of same-day discharge.Methods This is a comparative study of pain management protocols for patients undergoing the Nuss procedure at a single center from 2016 through 2020. All patients underwent the the same surgical technique for the treatment of pectus excavatum at a single center. Patients received bilateral PVB with continuous infusion (Group 1, n = 12), bilateral PVB with infusion and right-side cryoablation (Group 2, n = 9), or bilateral single-shot PVB and bilateral cryoablation (Group 3, n = 17). The primary outcome was LOS with focus on same-day discharge, and the secondary outcome was decreased opioid usage.ResultsEleven of 17 patients in Group 3 (65%) (bilateral single-shot PVB and bilateral cryoablation) were discharged the same day as surgery. The remaining Group 3 patients were discharged the following day with no complications or interventions. Compared to Group 1 (no cryoablation), Group 3 had shorter LOS (median 4.4 days vs. 0.7 days, respectively, p < 0.001) and significantly decreased median opioid use on the day of surgery (0.92 mg/kg vs. 0.47 mg/kg, p = 0.006).Conclusion Findings demonstrate the feasibility of multimodal pain management for same-day discharge after the Nuss procedure. Future multisite studies are needed to investigate the superiority of this approach to established methods.Level of EvidenceIII.

Surgical treatment of children with asymmetric pectus excavatum: Literature review

BACKGROUND: The surgical treatment of children with pectus excavatum is regarded as an urgent problem still demanding solution despite the multitudes of surgical correction methods available nowadays. The currently available well-known techniques cannot be considered perfect because they are not proper enough for solving all the tasks, not to mention the problem of asymmetric forms of pectus excavatum treatment.&#x0D; AIM: To analyze publications containing information on the methods of surgical treatment used for children with pectus excavatum.&#x0D; MATERIALS AND METHODS: The study presents the results of literature review on the methods of surgical correction of pectus excavatum. Information was retrieved in PubMed, Google Scholar, and eLibrary scientific databases using keywords. Consequently, 63 foreign and domestic scientific sources over the period from 1609 to 2022 were identified. Among them, 29 publications refer to the latest decade.&#x0D; RESULTS: Given the variety of methods used for chest deformity correction, thoracoplasty by D. Nuss has become the gold standard for the treatment of pectus excavatum. However, according to the search results, it is impossible to name one universal method of surgical intervention that could solve all the urgent problems at present. Modern surgery methods used for pectus excavatum correction can be considered only as modifications of treatment methods having been used before.&#x0D; CONCLUSIONS: The shortcomings of modern thoracoplasty determine the necessity to keep searching for new techniques and improve those available at present. Besides, the standard suitable for both surgeons and patients should be elaborated.

Pectus excavatum without surgery; can physical therapy improve chest wall or cardiopulmonary function?

<h3>Objective(s)</h3> To investigate available evidence regarding physical therapy (PT) for management of uncorrected pectus excavatum (PE) in adults. PE, inward sternal displacement, can reduce chest wall mobility, cardiopulmonary function, and activity tolerance. <h3>Data Sources</h3> PubMed, ProQuest Nursing & Allied Health Premium, Cochrane Library, CINAHL Complete, and Academic Search Complete were searched for English-language articles (1931-2021), using terms: pectus excavatum and treatment, conservative, surgical indications, physical therapy, exercise and cardiopulmonary. <h3>Study Selection</h3> Sixty-one articles were identified. Articles were excluded only for not addressing treatment. Twenty-two were included by multiple reviewers for further review and data extraction, as they addressed treatment for PE in adult or pediatric populations. <h3>Data Extraction</h3> Available evidence is scarce, hindering an evaluation of quality. For selected studies, 3 reviewers extracted data into a modified PICOT framework. <h3>Data Synthesis</h3> Seven articles included conservative management, with addressing exercise or PT. One experiment suggested significant improvement in pulmonary function and activity tolerance in children with PE after completing an exercise program. The lone study addressing effects of exercise in an adult with PE concluded that PT provided significant improvement. Three studies treated exercise as a possible confounder to the results, eg, noting the potential effects of baseline fitness levels or varying participation in exercise. <h3>Conclusions</h3> Two studies targeted PT treatment, one in children18 and the other a single adult. Both suggested potential benefit. Additionally, several articles acknowledged that exercise may have confounded the results, and may speak to the utility of PT as an effective treatment. Surgery carries significant risk, and there is no standard of care for the 50% or more who are not surgical candidates. This review highlights the need for investigation into the effects of PT for this population. <h3>Author(s) Disclosures</h3> There is no conflict of interested associated with this study for any of the authors.

First experience of using a vacuum bell in the treatment of pectus excavatum in children

BACKGROUND: To date, N.F. Filatov Childrens Hospital has great experience in the surgical correction of pectus excavatum in children. For 22 years, 1000 minimally invasive repair procedures of pectus excavatum were performed in the thoracic surgery department. Despite the satisfactory and excellent outcomes of the surgical correction of pectus excavatum, the search for alternative nonsurgical methods of treating this pathology continues. In world practice, a vacuum bell is used as a conservative treatment. However, its effectiveness and indications are still in question.&#x0D; AIM: To evaluate the first experience of using a vacuum bell in the treatment of pectus excavatum in children.&#x0D; MATERIALS AND METHODS: A vacuum bell is a device consisting of sight glass, silicone ring, and manual pump, lifting chest wall deformities through a vacuum. The device is selected individually depending on the growth and shape of the ventral surface of the chest. According to instructions, the vacuum bell should be used a minimum of 1 h per day. All patients underwent a standardized assessment of the results of treatment every 36 months: measuring the depth of deformation, visual treatment control, analysis of photo documentation, and questionnaires.&#x0D; RESULTS: In the N.F. Filatov Childrens Hospital from 2015 to 2021, treatment results of 35 children using vacuum bell for 636 months were analyzed. Patients were divided into two groups depending on the percentage of deformation correction. The first group included 23 (65.7%) patients, and the percentage of correction was 50%. The second group included 12 (34.3%) patients, and the percentage of correction was 50%. In these groups, the main differences in the age of treatment initiation, regularity of use, and time of daily use have influenced the results. In the first and second groups, the average ages were 8.7 2.69 and 13.7 3.56 years, and the average daily use times were 5.7 2.04 and 3.6 1.61 h/day, respectively.&#x0D; CONCLUSIONS: Vacuum bell therapy is an effective and safe method for correcting pectus excavatum in children, and in some cases, it can be an alternative to surgical treatments.

Separation of the seventh costal-sternal junction−A new technique to improve outcomes for the Nuss procedure for pectus excavatum

In the standard Nuss procedure for pectus excavatum, the costal arch is often elevated together with the sternum, resulting in unevenness of the lower part of the thorax. This complication is commonly called rib flaring. This paper presents a technique to avoid rib flaring and evaluates its effectiveness. In our technique, a part of the seventh costal cartilage is removed, disconnecting the costal arch from the sternum. The effectiveness of this technique was evaluated in a retrospective clinical study of 63 pectus excavatum patients who were randomly collected and were divided into two groups. One group-defined as the Standard Group-includes 27 patients (29.8±6.5SD y/o) on whom standard Nuss procedure was conducted; the other group-defined as the Separation Group-includes 36 patients (31.8±6.1SD y/o) on whom the cartilage removal was conducted in addition to the standard Nuss procedure. The degree of postoperative costal-arch elevation was defined as ECA (Elevation of Costal Arch) and was compared between the two groups. ECA was significantly greater for the Standard Group (10.2±3.3SD mm) than for the Separation Group (-1.1±3.42SDmm). Postoperative protrusion of the costal arch is prevented by the separation of the seventh costal cartilage from the sternum. Our original technique is a useful option for the treatment of pectus excavatum.

Wang procedure for treatment of asphyxiating thoracic deformity

Asphyxiating thoracic dystrophy is a rare and dangerous thoracic deformity, and its operation is challenging. In the past, several operations have been reported, but they all have disadvantages. Wang procedure is a new method for the treatment of pectus excavatum. Because this procedure can effectively eliminate various chest wall depressions, we use it in the treatment of asphyxiating thoracic dystrophy. This paper reports the use of Wang procedure in a 10-year-old child with asphyxiating thoracic dystrophy, and the result of the operation was satisfactory.

Death cases related to Nuss procedure

Nuss procedure is a revolution of pectus excavatum treatment, however, it has fatal complications. Because few surgeons are willing to report their own death cases, there are almost no relevant reports in the literature. Through private communication with peers, we learned lots of information about such death cases.

Experience of the Wang procedure in treating pectus excavatum in two hundred fifty-six paediatric patients.

To analyze and summarize the orthopaedic effect and application experience of the Wang procedure in the treatment of pectus excavatum in paediatric patients. The clinical data of 256 children ranging from 0.83~14 years (4.89±2.83 years) who underwent the Wang procedure for pectus excavatum from January 2017 to September 2020 in our hospital were analyzed retrospectively. A 1~2-cm incision was made in front of the xiphoid, and a tunnel was constructed on the deep surface of the thoracic cage. Steel wires were inserted through the bilateral costal arch and the lower sternum, and a steel bar was placed in the tunnel. The wires were pulled taut and fixed to the bar, and the incision was sutured. All the procedures were performed using one steel bar. The range of the procedure duration, the intra-operative bleeding volume, and the hospitalization stays of the patients were 18 to 45 (24.02±4.89) minutes, one to ten (2.16±1.68) mL, and three to nine days (5.71±1.35 days) respectively. Post-operative pneumothorax occurred in three cases without other complications. All the cases received follow-up for one to 45 months after discharge, during which six cases experienced poor wound healing, removed steel plate in 82 cases, and three cases of pectus excavatum recurrence. The Wang procedure is a good option for treating pectus excavatum, secondary pectus excavatum, or recurrent pectus excavatum in paediatric patients.