A simple technique for preventing bar displacement with the nuss repair of pectus excavatum

• Published in: Journal of pediatric surgery Vol. 36; no. 8; pp. 1266 - 1268
• Main Authors: Hebra, André, Gauderer, Michael W.L., Tagge, Edward P., Adamson, William T., Othersen, H.Biemann
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.08.2001; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Chest wall deformities; Child; Child, Preschool; Female; Foreign-Body Migration - prevention & control; Funnel Chest - diagnostic imaging; Funnel Chest - surgery; Humans; Male; Medical sciences; minimally invasive surgery; Minimally Invasive Surgical Procedures - instrumentation; Minimally Invasive Surgical Procedures - methods; Nuss procedure; pectus bar; Pectus excavatum; Pneumology; Radiography; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Surgical Equipment - adverse effects; Suture Techniques; thoracic abnormalities; Thoracic Surgical Procedures - instrumentation; Thoracic Surgical Procedures - methods; Treatment Outcome; Pectus excavatum; pectus bar; minimally invasive surgery; Chest wall deformities; thoracic abnormalities; Nuss procedure; Human; Stabilization; Lateral; Diseases of the osteoarticular system; Congenital disease; Displacement; Retrospective; Result; Plasty; Prevention; Bar; Fixation; Treatment; Malformation; Surgery; Technique; Chest wall; Child
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2001.25791

Background/Purpose: The most common complication of the minimally invasive technique for repair of pectus excavatum (MIRPE) is bar displacement, which has been reported to occur in 9.5% of all cases, particularly in teenaged patients. The use of a lateral stabilizing bar has improved stability but has not eliminated the occurrence of this problem. The authors report a new technique added to the standard MIRPE that creates an additional third point of fixation of the pectus bar to prevent displacement. Methods: The technique requires the simple placement, via a spinal needle, of a nonabsorbable suture next to the sternum, encircling a rib and the bar, using a single 3-mm stab wound and thoracoscopic guidance. The suture simply is buried under the skin. Since 1998, this technique has been applied to 20 patients who underwent MIRPE. Results: The average age was 14 years; 80% were boys. Average operating time was 75 minutes, and all patients had thoracoscopy with the MIRPE. A lateral stabilizing bar also was used in 14 patients. Four patients had 2 struts placed. Average length of stay was 5.5 days. There were no early complications. Mean follow-up was 12 months. Bar displacement occurred in 1 patient early in the series in which an absorbable suture was used for fixation. One patient had a prolonged hospital stay of 7 days because of postoperative pain. Conclusions: This modification to the original technique of MIRPE creates a 3-point fixation system that minimizes the risk of bar shifting even in teenaged patients. It does not add any significant time or cost to the operation, and it is fairly simple to perform. The authors believe that this technique decreases the occurrence of bar displacement, and they recommend its use for all patients with pectus excavatum considered candidates for the Nuss repair. J Pediatr Surg 36:1266-1268. Copyright © 2001 by W.B. Saunders Company.