Experience of surgical treatment of funnel deformity of the chest


Keywords: funnel deformity of the chest; оperation in accordance to Nass procedure

Abstract

Objective. To estimate the results of surgical treatment of funnel deformity of the chest in accordance to Nass procedure.

Маterials and methods. In 175 patients, suffering FDCH, miniinvasive correction in accordance to Nassa procedure was accomplished.

Results. In 162 (92.6%) patients the ideal cosmetic result was noted. In 157 (89.7%) patients one fixator was used, in 17 (9.7%) – two, in 1 (0.6%) patients – three. Average duration of operation have constituted 52 min (from 30 tо 104 min), average term of postoperative stationary stay - 8 days (from 5 tо 11 days).

Conclusion. The operation in accordance to Nass procedure constitutes a gold standard in treatment of FDCH in adults and children, guarantees good cosmetic result of treatment, promotes improvement of cardiac and respiratory functions, eliminates dysfunction of anterior wall of thoracic cage in a respiratory act.

References

1. Nuss D, Kelly R, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998 Apr;33(4):545–52. http://dx.doi.org/10.1016/S0022-3468(98)90314-1.

2. Croitoru DP, Kelly RE Jr, Goretsky MJ, Lawson ML, Swoveland B, Nuss D. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg. 2002 March;37(3):437-45. http://dx.doi.org/10.1053/jpsu.2002.30851.

3. Hebra A. Minimally invasive pectus surgery. Chest Surg Clin N Am. 2000;10:329–39, v ii. PMID: 10803337.

4.Watanabe A, Watanabe T, Obama T, Ohsawa H, Mawatari T, Ichimiya Y, et al. The use of a lateral stabilizer increases the incidence of wound trouble following the Nuss procedure. Ann Thorac Surg 2004 January;77(1): 296–300. http://dx.doi.org/10.1016/S0003-4975(03)01335-3.

5. Molik KA, Engum SA, Rescorla FJ, West KW, Scherer LR, Grosfeld JL. Pectus excavatum repair: experience with standard and minimal invasive techniques. J Pediatr Surg. 2001 February;36(2):324–8. http://dx.doi.org/10.1053/jpsu.2001.20707.

6. Schalamon J, Pokall S, Windhaber J, Hoellwarth ME. Minimally invasive correction of pectus excavatum in adult patients. J Thorac Cardiovasc Surg. 2006 September;132(3):524-9. http://dx.doi.org/10.1016/j.jtcvs.2006.04.038.

7. Aronson DC, Bosgraaf RP, van der HC, Ekkelkamp S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World J Surg. 2007 January;31(1):26–9. http://dx.doi.org/10.1007/s00268-005-0779-1.

8. Kim DH, Hwang JJ, Lee MK, Lee DY, Paik HC. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg 2005 September; 80(3):1073 – 7. http://dx.doi.org/10.1016/j.athoracsur.2005.03.070.

9. Hebra A, Swoveland B, Egbert M, Tagge EP , Georgeson K, Othersen H Jr, et al. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg. 2000 February;35(2):252-7. http://dx.doi.org/10.1016/S0022-3468(00)90019-8.

10. Park HJ, Lee SY, Lee CS, Youm W, Lee KR. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg 2004 January77(1):289–95. http://dx.doi.org/10.1016/S0003-4975(03)01330-4.

11. Ravitch MM. The operative treatment of pectus excavatum. J Pediatr 1956April;48(4):465–72. http://dx.doi.org/10.1016/S0022-3476(56)80075-9.

12. Iida H, Sudo Y, Yamada Y, Matsushita Y, Eda K, Inoue Y. Nonprosthetic surgical repair of pectus excavatum. Ann Thorac Surg. 2006 Aug;82(2):451– 6. http://dx.doi.org/10.1016/j.athoracsur.2006.03.052.

13. Davis JT, Weinstein S. Repair of the pectus deformity: results of the Ravitch approach in the current era. Ann Thorac Surg 2004 August;78(2):421–6. http://dx.doi.org/10.1016/j.athoracsur.2004.03.011.

14. Fonkalsrud EW. Open repair of pectus excavatum with minimal cartilage resection. Ann Surg 2004 August;240(2):231–5. http://dx.doi.org/10.1097/01.sla.0000133116.16484.bb.

15. Jaroszewski DE, Fonkalsrud EW. Repair of pectus chest deformities in 320 adult patients: 21 year experience. Ann Thorac Surg. 2007 August;84(2):429–33. http://dx.doi.org/10.1016/j.athoracsur.2007.03.077.

16. Wang LS, Kuo KT, Wang HW, Yang CH, Chin T. A novel surgical correction through a small transverse incision for pectus excavatum. Ann Thorac Surg. 2005 November;80(5):1951–4. http://dx.doi.org/10.1016/j.athoracsur.2004.05.029.

17. 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 January;29(1):1-5. http://dx.doi.org/10.1016/j.ejcts.2005.09.018.

18. 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 Mar;20(2):85-91. http://dx.doi.org/10.1055/s-0029-1243621.

19. Haecker FM. The vacuum bell for conservative treatment of pectus excavatum: the Basle experience. Pediatr Surg Int. 2011June;27(6):623-7. http://dx.doi.org/10.1007/s00383-010-2843-7.

20. O'Keefe J, Byrne R, Montgomery M, Harder J, Roberts D, Sigalet DL. Longer term effects of closed repair of pectus excavatum on cardiopulmonary status. J Pediatr Surg. 2013 May;48(5):1049-54. http://dx.doi.org/10.1016/j.jpedsurg.2013.02.024.

21. Lesbo M, Tang M, Nielsen HH, Jorgen F, Lundorf E, Pilegaard HK. Compromised cardiac function in exercising teenagers with pectus excavatum. Interact Cardiovasc Thorac Surg. 2011 October;13(4):377-80. http://dx.doi.org/10.1510/icvts.2011.267054.

22. Gurkan U, Aydemir B, Aksoy S, Akgoz H, Tosu AR, Gungor B, et al. Echocardiographic assessment of right ventricular function before and after surgery in patients with pectus excavatum and right ventricular compression. Thorac Cardiovasc Surg. 2014; Apr;62(3):231-5. http://dx.doi.org/10.1055/s-0033-1342941.

23. Redlinger RE, Jr, Kelly RE, Nuss D, Goretsky M, Kuhn MA, Sullivan K, et al. Regional chest wall motion dysfunction in patients with pectus excavatum demonstrated via optoelectronic plethysmography. J Pediatr Surg. 2011 June;46(6):1172-6. J Pediatr Surg http://dx.doi.org/10.1016/j.jpedsurg.2011.03.047.

Author Biographies


Ya. V. Fishchenko, Institute of Traumatology and Orthopedics, Kyiv

Fishchenko Iakiv - D.SC, orthopedist, neurosurgeon.
Leading Researcher Department of Spinal Surgery,
Institute of Traumatology and Orthopedics
Address: st. Boulvarno - Kudryavskaya 27,Kiev, 01601 Ukraine.
Phone: +380(50) 3808725
(044) 221- 08-30
E-mail: fishchenko@gmail.com
ORCID: https://orcid.org/0000-0001-7446-0016


A. V. Shevchuk, Institute of Traumatology and Orthopedics, Kyiv

Shevchuk A.V. – PhD, orthopedist,
Senior Researcher Department of Spinal Surgery,
Institute of Traumatology and Orthopedics
Address: st. Boulvarno - Kudryavskaya 27,Kiev, 01601 Ukraine.
Phone: +380(97) 1308460
E-mail: fasti@i.ua
https://orcid.org/0000-0003-3829-9231


A. I. Saponenko, Institute of Traumatology and Orthopedics, Kyiv

Saponenko A.I. – orthopedist,
Department of Spinal Surgery,
Institute of Traumatology and Orthopedics
Address: st. Boulvarno - Kudryavskaya 27,Kiev, 01601 Ukraine.
Phone: +380(97) 6553221
E-mail: saponchikk@gmail.com
https://orcid.org/0000-0001-7257-3383


L. D. Kravchuk, Institute of Traumatology and Orthopedics, Kyiv

Kravchuk Lyudmila, Associate Professor
Physical Rehabilitation Department,
National University of Physical Education and Sports of Ukraine
Address: st. Fizkultury, 1; Kyiv, Ukraine, 03680.
Phone: +380(097)8774167
kravchukwww@gmail.com
ORCID: https://orcid.org/0000-0002-5317-0420

Published
2019-02-27
How to Cite
Fishchenko, Y. V., Shevchuk, A. V., Saponenko, A. I., & Kravchuk, L. D. (2019). Experience of surgical treatment of funnel deformity of the chest. Klinicheskaia Khirurgiia, 86(2), 53-56. https://doi.org/10.26779/2522-1396.2019.02.53
Section
General Problems of Surgery