doiSerbia

Minimal invasive surgical correction of pectus excavatum deformities in adolescents: Our institutional experience

Jokić Radoica (Klinika za dečju hirurgiju, Institut za zaštitu zdravlja dece i omladine Vojvodine, Novi Sad)
Kravarušić Dragan (Schneider Children’s Medical Center, Israel University, Tel Aviv, Israel)
Pajić Miloš (Klinika za dečju hirurgiju, Institut za zaštitu zdravlja dece i omladine Vojvodine, Novi Sad)
Antić Jelena (Klinika za dečju hirurgiju, Institut za zaštitu zdravlja dece i omladine Vojvodine, Novi Sad)
Vukašinović Zoran (Medicinski fakultet, Beograd + Institut za ortopedsko­hirurške bolesti „Banjica“, Beograd)

Introduction. Nuss procedure is a minimal invasive surgical technique based on retrosternal placement of a metal plate to correct pectus excavatum chest deformity. We are presenting our five­year (2006­2011) institutional experience of 21 patients. Objective. The aim of this study was to determine characteristics and advantages of minimal invasive surgical approach in correcting deformities of the chest. Methods. Surgical procedure, named after its author Nuss, involves the surgical placement of a molded metal plate, the so­called pectus bar, behind the sternum under thoracoscopic view whereby immediate controlled intraoperative corrections and stabilizations of the depression can be made. The great advantage of this method is reflected in a significant shortening of operative time, usually without indications for compensation in blood volume, and with a significantly shortened postoperative recovery that allows patients to quickly return to their normal activities. Results. In the period 2006­2011, 21 patients were operated by the Nuss procedure. The pectus bar was set in front or behind the muscles of the chest. Among the complications listed were inflammation of wounds in three patients, dislocation (shifting) of the bar requiring a reoperation in two patients, an occurrence of a pericardial effusion in one patient, and allergic response to foreign body in one patient. Five patients required extraction of the bar two years later, and three patients after three years, all with excellent results. Conclusion. Minimally invasive Nuss procedure is safe and effective. It currently represents the primary method of choice for solving the chest deformity pectus excavatum for patients of all ages. Modification of thoracoscopic control allows a safe field of operation. Postoperative results are excellent with very few complications that can be attributed to the learning curve.

Keywords: pectus excavatum, minimal invasive repair, children