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Minimal Invasive Repair of Pectus Excavatum

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Chest Wall Deformities and Corrective Procedures

Abstract

The modern era of correction of pectus excavatum (PE) started in 1949 by Ravitch. Since several modifications to the technique were published, but it was the standard way to correct PE for long time. Prof Nuss’s minimally technique changed the strategy for correction and seems now to be the standard technique for surgeons who correct PE. The optimal age for surgery is discussed. Most surgeons prefer that the patient is in the beginning of the puberty so the bar system is in situ through the growth spurt. It looks like that this decreases the recurrence rate. At this age the patients are also aware of the restrictions which are in the beginning of the treatment. But recently it has been offered to patient up to 40 years of age. Bar removal is done 3 years after correction and is a day surgery project. In most cases it is only necessary to open the incision where you have the stabilizer if you use the short bar technique. The complication are few in experienced hands. Most of the patients get a very beautiful result and are very satisfied with the operation.

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References

  1. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg. 1949;129:429–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. 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;33:545–52.

    Article  CAS  PubMed  Google Scholar 

  3. Pilegaard HK, Licht PB. Routine use of minimally invasive surgery for pectus excavatum in adults. Ann Thorac Surg. 2008;86:952–6.

    Article  PubMed  Google Scholar 

  4. Pilegaard HK. Extending the use of Nuss procedure in patients older than 30 years. Eur J Cardiothorac Surg. 2011;40:334–7.

    PubMed  Google Scholar 

  5. Nuss D. Recent experiences with minimally invasive pectus excavatum repair “Nuss procedure”. Jpn J Thorac Cardiovasc Surg. 2005;53:338–44.

    Article  PubMed  Google Scholar 

  6. 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;7:54–7.

    Article  PubMed  Google Scholar 

  7. Pilegaard HK, Licht PB. Can absorbable stabilizers be used routinely in the Nuss procedure? Eur J Cardiothorac Surg. 2009;35:561–4.

    Article  PubMed  Google Scholar 

  8. Krasopoulos G, Goldstraw P. Minimally invasive repair of pectus excavatum deformity. Eur J Cardiothorac Surg. 2010.

    Google Scholar 

  9. Kelly Jr RE. Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg. 2008;17:181–93.

    Article  PubMed  Google Scholar 

  10. Roberts J, Hayashi A, Anderson JO, Martin JM, Maxwell LL. Quality of life of patients who have undergone the Nuss procedure for pectus excavatum: preliminary findings. J Pediatr Surg. 2003;38:779–83.

    Article  PubMed  Google Scholar 

  11. Lawson ML, Cash TF, Akers R, Vasser E, Burke B, Tabangin M, Welch C, Croitoru DP, Goretsky MJ, Nuss D, Kelly Jr RE. A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J Pediatr Surg. 2003;38:916–8.

    Article  PubMed  Google Scholar 

  12. Krasopoulos G, Dusmet M, Ladas G, Goldstraw P. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Eur J Cardiothorac Surg. 2006;29:1–5.

    Article  PubMed  Google Scholar 

  13. Metzelder ML, Kuebler JF, Leonhardt J, Ure BM, Petersen C. Self and parental assessment after minimally invasive repair of pectus excavatum: lasting satisfaction after bar removal. Ann Thorac Surg. 2007;83:1844–9.

    Article  PubMed  Google Scholar 

  14. Kelly Jr RE, Cash TF, Shamberger RC, Mitchell KK, Mellins RB, Lawson ML, Oldham K, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb 3rd GW, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Bagley T, Quinn A, Moskowitz AB. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics. 2008;122:1218–22.

    Article  PubMed  Google Scholar 

  15. Lam MW, Klassen AF, Montgomery CJ, LeBlanc JG, Skarsgard ED. Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures. J Pediatr Surg. 2008;43:819–25.

    Article  PubMed  Google Scholar 

  16. Jacobsen EB, Thastum M, Jeppesen JH, Pilegaard HK. Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg. 2010;20:85–91.

    Article  PubMed  Google Scholar 

  17. Redlinger Jr RE, Kelly RE, Nuss D, Goretsky M, Kuhn MA, Sullivan K, Wootton AE, Ebel A, Obermeyer RJ. Regional chest wall motion dysfunction in patients with pectus excavatum demonstrated via optoelectronic plethysmography. J Pediatr Surg. 2011;46:1172–6.

    Article  PubMed  Google Scholar 

  18. Redlinger Jr RE, Wootton A, Kelly RE, Nuss D, Goretsky M, Kuhn MA, Obermeyer RJ. Optoelectronic plethysmography demonstrates abrogation of regional chest wall motion dysfunction in patients with pectus excavatum after Nuss repair. J Pediatr Surg. 2012;47:160–4.

    Article  PubMed  Google Scholar 

  19. Lesbo M, Tang M, Nielsen HH, Frokiaer J, Lundorf E, Pilegaard HK, Hjortdal VE. Compromised cardiac function in exercising teenagers with pectus excavatum. Interact Cardiovasc Thorac Surg. 2011;13:377–80.

    Article  PubMed  Google Scholar 

  20. Maagaard M, Tang M, Ringgaard S, Nielsen HH, Frokiaer J, Haubuf M, Pilegaard HK, Hjortdal VE. Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation. Ann Thorac Surg. 2013;96:272–8.

    Article  PubMed  Google Scholar 

  21. de Campos JR, Fonseca MH, Werebe Ede C, Velhote MC, Jatene FB. Technical modification of the Nuss operation for the correction of pectus excavatum. Clinics (Sao Paulo). 2006;61:185–6.

    Article  Google Scholar 

  22. Knudsen MR, Nyboe C, Hjortdal VE, Pilegaard HK. Routine postoperative chest X-ray is unnecessary following the Nuss procedure for pectus excavatum. Interact Cardiovasc Thorac Surg. 2013;16:830–3.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nyboe C, Knudsen MR, Pilegaard HK. Elective pectus bar removal following Nuss procedure for pectus excavatum: a single-institution experience. Eur J Cardiothorac Surg. 2011;39:1040–2.

    Article  PubMed  Google Scholar 

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Correspondence to Hans K. Pilegaard MD .

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Pilegaard, H.K. (2016). Minimal Invasive Repair of Pectus Excavatum. In: Kolvekar, S., Pilegaard, H. (eds) Chest Wall Deformities and Corrective Procedures. Springer, Cham. https://doi.org/10.1007/978-3-319-23968-2_9

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  • DOI: https://doi.org/10.1007/978-3-319-23968-2_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23966-8

  • Online ISBN: 978-3-319-23968-2

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