PDF herunterladen
Thorac Cardiovasc Surg 2016; 64(01): 078-082
DOI: 10.1055/s-0035-1556818
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Emerging Fixation Technique to Prevent Pectus Bar Displacement: Needlescope-Assisted 3-Point Fixation

Gyeol Yoo
1   Department of Plastic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Eun Young Rha
1   Department of Plastic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Jin Yong Jeong
2   Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Jongho Lee
3   Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Sung Bo Sim
4   Department of Thoracic and Cardiovascular Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
,
Keon Hyon Jo
5   Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
› Institutsangaben
Weitere Informationen

Publikationsverlauf

26. März 2015

08. Mai 2015

Publikationsdatum:
16. August 2015 (online)

    Lizenzen und Reprints Alle Artikel dieser Rubrik

Abstract

Background Bar flipping displacement is one of the most common complications after the Nuss procedure for pectus excavatum. We evaluated the results of a modified Nuss procedure with needlescope-assisted bar fixation.

Methods The records of 41 patients with pectus excavatum who underwent single pectus bar insertion with the Nuss procedure between July 2011 and August 2014 were retrospectively reviewed. The patients were divided into two groups: those who did not undergo 3-point fixation (group A) and those who did undergo 3-point fixation (group B).

Results There were 36 male patients and 5 female patients with a mean age of 10.7 ± 8.3 years (range: 3–36 years). The postoperative Haller index (HI) (2.61 ± 0.42) was significantly lower than the preoperative HI (3.91 ± 1.07; p < 0.01). The angle of the initial bar position was 5.59 ± 7.37 degrees in group A and 8.52 ± 9.61 degrees in group B, with no significant difference between the groups (p > 0.05). The rate of reoperation to correct bar displacement was lower in group B (3.3%) than in group A (9.1%).

Conclusion Needlescope-assisted 3-point fixation of the bar was performed without an additional skin incision and showed a low rate of reoperation to correct displacement of the pectus bar.

Keywords

pectus excavatum - Nuss procedure - thoracoscopy/VATS - complication - bar displacement

Note

No funding was received in support of this work.


 

  • References

  • 1 Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (4) 545-552
    CrossrefPubMedGoogle Scholar
  • 2 Kelly RE, Goretsky MJ, Obermeyer R , et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg 2010; 252 (6) 1072-1081
    CrossrefPubMedGoogle Scholar
  • 3 Hebra A, Swoveland B, Eqbert M , et al. Outcome analysis of minimally invasive repair of pecuts excavatum: review of 251 cases. J Pediatr Surg 2000; 35 (2) 252-257 , discussion 257–258
    CrossrefPubMedGoogle Scholar
  • 4 Pilegaard HK, Licht PB. Early results following the Nuss operation for pectus excavatum—a single-institution experience of 383 patients. Interact Cardiovasc Thorac Surg 2008; 7 (1) 54-57
    CrossrefPubMedGoogle Scholar
  • 5 Park HJ, Jeong JY, Jo WM , et al. Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach. J Thorac Cardiovasc Surg 2010; 139 (2) 379-386
    CrossrefPubMedGoogle Scholar
  • 6 Nuss D, Croitoru DP, Kelly Jr RE, Goretsky MJ, Nuss KJ, Gustin TS. Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 2002; 12 (4) 230-234
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Tedde ML, Campos JR, Das-Neves-Pereira JC, Abrāo FC, Jatene FB. The search for stability: bar displacement in three series of pectus excavatum patients treated with the Nuss technique. Clinics (Sao Paulo) 2011; 66 (10) 1743-1746
    CrossrefPubMedGoogle Scholar
  • 8 Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg 2004; 39 (3) 391-395 , discussion 391–395
    CrossrefPubMedGoogle Scholar
  • 9 Uemura S, Nakagawa Y, Yoshida A, Choda Y. Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int 2003; 19 (3) 186-189
    CrossrefPubMedGoogle Scholar
  • 10 Del Frari B, Schwabegger AH. How to avoid pectus bar dislocation in the MIRPE or MOVARPE technique: results of 12 years' experience. Ann Plast Surg 2014; 72 (1) 75-79
    CrossrefPubMedGoogle Scholar
  • 11 Jeong JY, Lee J. How to avoid pectus bar displacement in the MIRPE or MOVARPE technique: results of 12 years' experience. Ann Plast Surg 2015; 74 (4) 515-516
    PubMedGoogle Scholar
  • 12 Hebra A, Gauderer MW, Tagge EP, Adamson WT, Othersen Jr HB. A simple technique for preventing bar displacement with the Nuss repair of pectus excavatum. J Pediatr Surg 2001; 36 (8) 1266-1268
    CrossrefPubMedGoogle Scholar
  • 13 Stanfill AB, DiSomma N, Henriques SM, Wallace LJ, Vegunta RK, Pearl RH. Nuss procedure: decrease in bar movement requiring reoperation with primary placement of two bars. J Laparoendosc Adv Surg Tech A 2012; 22 (4) 412-415
    CrossrefPubMedGoogle Scholar
  • 14 Jeong JY, Lee J. Needlescope-assisted 3-point fixation of the pectus bar in the Nuss procedure. J Thorac Cardiovasc Surg 2014; 147 (5) 1721-1722
    PubMedGoogle Scholar
  • 15 Park HJ, Chung WJ, Lee IS, Kim KT. Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum. J Pediatr Surg 2008; 43 (1) 74-78
    CrossrefPubMedGoogle Scholar
  • 16 Castellani C, Schalamon J, Saxena AK, Höellwarth ME. Early complications of the Nuss procedure for pectus excavatum: a prospective study. Pediatr Surg Int 2008; 24 (6) 659-666
    CrossrefPubMedGoogle Scholar