Minimally invasive sternal depression by autologous force for pectus carinatum repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAI Yixin ¹ , HAN Ying ² , CAI Zhen ¹ , ZHANG Ni ¹ , WANG Jie ¹ ,  FU Xiangning ¹

1. Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;
2. Department of Infection Control, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;

Corresponding author：

FU Xiangning, Email: fuxn2006@aliyun.com

Keywords：

Pectus carinatum; minimally invasive; sternal depression by autologous force

DOI：

10.7507/1007-4848.201606007

Video：

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Objective To investigate the feasibility and clinical outcomes of minimally invasive sternal depression by autologous force for the correction of pectus carinatum. Methods Between October 2011 and September 2015, 22 pectus carinatum patients underwent minimally invasive surgical correction of pectus carinatum in Tongji Hospital. Clinical data of 22 patients were retrospectively analyzed. There were 19 males and 3 females with a mean age of 12.00±2.87 years, ranging from 6 to 15 years. Among them, 17 patients were symmetric malformation, and the others were asymmetric. Preoperative chest CT scan was performed on 14 patients. Haller index was 1.65-2.23 (1.97±0.15). All the patients underwent the minimally invasive surgical correction of pectus carinatum with a NUSS bar via sternal depression by autologous force. Results All the operations were completed successfully. The mean operation time was 55-120 (83.73±16.62) min and blood loss volume was 10-50 (28.18±11.63) ml. The mean postoperative hospital stay was 3-6 (4.23±1.17) d. Postoperative complications included wound infection in 2 patients, minor pneumothorax in 3 patients, who were cured by conservative treatment. One patient suffering postoperative hydropneumothorax received drainage. All the patients were followed up for 6-48 months after discharge and very satisfied with the chest appearance following surgery. No patient complained of persistent pain. There was no displacement of the bar or the stabilizers. Nine patients underwent the removal of the NUSS bar without pectus carinatum recurrence. Conclusion Minimally invasive sternal depression by autologous force simplifies the procedure of correction of pectus carinatum with reliable and satisfactory outcomes.

Citation： CAI Yixin, HAN Ying, CAI Zhen, ZHANG Ni, WANG Jie, FU Xiangning. Minimally invasive sternal depression by autologous force for pectus carinatum repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(4): 290-294. doi: 10.7507/1007-4848.201606007 Copy

1.	Coelho Mde S, Guimarães Pde S. Pectus carinatum. J Bras Pneumol, 2007, 33(4): 463-474.
2.	Kuru P, Cakiroglu A, Er A, et al. Pectus excavatum and pectus carinatum: associated conditions, family history, and postoperative patient satisfaction. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 29-34.
3.	Abramson H, D'Agostino J, Wuscovi S. A 5-year experience with a minimally invasive technique for pectus carinatum repair. J Pediatr Surg, 2009, 44(1): 118-123.
4.	Yuksel M, Bostanci K, Evman S. Minimally invasive repair of pectus carinatum using a newly designed bar and stabilizer: a single-institution experience. Eur J Cardiothorac Surg, 2011, 40(2): 339-342.
5.	Neves SC, Pinho AC, Fonseca JC, et al. Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach. Comput Methods Biomech Biomed Engin, 2015, 18(7): 711-720.
6.	Park CH, Kim TH, Haam SJ, et al. The etiology of pectus carinatum involves overgrowth of costal cartilage and undergrowth of ribs. J Pediatr Surg, 2014, 49(8): 1252-1258.
7.	Fonkalsrud EW. Surgical correction of pectus carinatum: lessons learned from 260 patients. J Pediatr Surg, 2008, 43(7): 1235-1243.
8.	Cobben JM, Oostra RJ, van Dijk FS. Pectus excavatum and carinatum. Eur J Med Genet, 2014, 57(8): 414-417.
9.	Fonkalsrud EW, Anselmo DM. Less extensive techniques for repair of pectus carinatum: the undertreated chest deformity. J Am Coll Surg, 2004, 198(6): 898-905.
10.	Coskun ZK, Turgut HB, Demirsoy S, et al. The prevalence and effects of pectus excavatum and pectus carinatum on the respiratory function in children between 7-14 years old. Indian J Pediatr, 2010, 77(9): 1017-1019.
11.	Steinmann C, Krille S, Mueller A, et al. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg, 2011, 40(5): 1138-1145.
12.	Krille S, Muller A, Steinmann C, et al. Self- and social perception of physical appearance in chest wall deformity. Body Image, 2012, 9(2): 246-252.
13.	Knudsen MV, Grosen K, Pilegaard HK, et al. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem. J Pediatr Surg, 2015, 50(9): 1472-1476.
14.	Loff S, Sauter H, Wirth T, et al. Highly efficient conservative treatment of pectus carinatum in compliant patients. Eur J Pediatr Surg, 2015, 25(5): 421-424.
15.	Suh JW, Joo S, Lee GD, et al. Minimally invasive repair of pectus carinatum in patients unsuited to bracing therapy. Korean J Thorac Cardiovasc Surg, 2016, 49(2): 92-98.
16.	Ravitch MM. Unusual sternal deformity with cardiac symptoms operative correction. J Thorac Surg, 1952, 23(2): 138-144.
17.	Ravitch MM. Operative correction of pectus carinatum (pigeon breast). Ann Surg, 1960, 151(5): 705-714.
18.	Bell R, Idowu O, Kim S. Minimally invasive repair of symmetric pectus carinatum: bilateral thoracoscopic chondrotomies and suprasternal compression bar placement. J Laparoendosc Adv Surg Tech A, 2012, 22(9): 921-924.
19.	Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin, 2010, 20(4): 563-574.
20.	Abramson H. A minimally invasive technique to repair pectus carinatum. Preliminary report. Arch Bronconeumol, 2005, 41(6): 349-351.
21.	Oncel M, Tezcan B, Akyol KG, et al. Clinical experience of repair of pectus excavatum and carinatum deformities. Cardiovasc J Afr, 2013, 24(8): 318-321.
22.	Robicsek F, Watts LT, Fokin AA. Surgical repair of pectus excavatum and carinatum. Semin Thorac Cardiovasc Surg, 2009, 21(1): 64-75.
23.	刘吉福, 徐波, 刘克强, 等. 改进微创技术治疗大龄鸡胸患者的近期疗效. 中国胸心血管外科临床杂志, 2013, 20(2): 235-237.
24.	肖海波, 张辅贤, 丁芳宝, 等. 微创胸骨沉降术矫治鸡胸. 中国胸心血管外科临床杂志, 2013, 20(5): 555-559.

1. Coelho Mde S, Guimarães Pde S. Pectus carinatum. J Bras Pneumol, 2007, 33(4): 463-474.
2. Kuru P, Cakiroglu A, Er A, et al. Pectus excavatum and pectus carinatum: associated conditions, family history, and postoperative patient satisfaction. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 29-34.
3. Abramson H, D'Agostino J, Wuscovi S. A 5-year experience with a minimally invasive technique for pectus carinatum repair. J Pediatr Surg, 2009, 44(1): 118-123.
4. Yuksel M, Bostanci K, Evman S. Minimally invasive repair of pectus carinatum using a newly designed bar and stabilizer: a single-institution experience. Eur J Cardiothorac Surg, 2011, 40(2): 339-342.
5. Neves SC, Pinho AC, Fonseca JC, et al. Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach. Comput Methods Biomech Biomed Engin, 2015, 18(7): 711-720.
6. Park CH, Kim TH, Haam SJ, et al. The etiology of pectus carinatum involves overgrowth of costal cartilage and undergrowth of ribs. J Pediatr Surg, 2014, 49(8): 1252-1258.
7. Fonkalsrud EW. Surgical correction of pectus carinatum: lessons learned from 260 patients. J Pediatr Surg, 2008, 43(7): 1235-1243.
8. Cobben JM, Oostra RJ, van Dijk FS. Pectus excavatum and carinatum. Eur J Med Genet, 2014, 57(8): 414-417.
9. Fonkalsrud EW, Anselmo DM. Less extensive techniques for repair of pectus carinatum: the undertreated chest deformity. J Am Coll Surg, 2004, 198(6): 898-905.
10. Coskun ZK, Turgut HB, Demirsoy S, et al. The prevalence and effects of pectus excavatum and pectus carinatum on the respiratory function in children between 7-14 years old. Indian J Pediatr, 2010, 77(9): 1017-1019.
11. Steinmann C, Krille S, Mueller A, et al. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg, 2011, 40(5): 1138-1145.
12. Krille S, Muller A, Steinmann C, et al. Self- and social perception of physical appearance in chest wall deformity. Body Image, 2012, 9(2): 246-252.
13. Knudsen MV, Grosen K, Pilegaard HK, et al. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem. J Pediatr Surg, 2015, 50(9): 1472-1476.
14. Loff S, Sauter H, Wirth T, et al. Highly efficient conservative treatment of pectus carinatum in compliant patients. Eur J Pediatr Surg, 2015, 25(5): 421-424.
15. Suh JW, Joo S, Lee GD, et al. Minimally invasive repair of pectus carinatum in patients unsuited to bracing therapy. Korean J Thorac Cardiovasc Surg, 2016, 49(2): 92-98.
16. Ravitch MM. Unusual sternal deformity with cardiac symptoms operative correction. J Thorac Surg, 1952, 23(2): 138-144.
17. Ravitch MM. Operative correction of pectus carinatum (pigeon breast). Ann Surg, 1960, 151(5): 705-714.
18. Bell R, Idowu O, Kim S. Minimally invasive repair of symmetric pectus carinatum: bilateral thoracoscopic chondrotomies and suprasternal compression bar placement. J Laparoendosc Adv Surg Tech A, 2012, 22(9): 921-924.
19. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin, 2010, 20(4): 563-574.
20. Abramson H. A minimally invasive technique to repair pectus carinatum. Preliminary report. Arch Bronconeumol, 2005, 41(6): 349-351.
21. Oncel M, Tezcan B, Akyol KG, et al. Clinical experience of repair of pectus excavatum and carinatum deformities. Cardiovasc J Afr, 2013, 24(8): 318-321.
22. Robicsek F, Watts LT, Fokin AA. Surgical repair of pectus excavatum and carinatum. Semin Thorac Cardiovasc Surg, 2009, 21(1): 64-75.
23. 刘吉福, 徐波, 刘克强, 等. 改进微创技术治疗大龄鸡胸患者的近期疗效. 中国胸心血管外科临床杂志, 2013, 20(2): 235-237.
24. 肖海波, 张辅贤, 丁芳宝, 等. 微创胸骨沉降术矫治鸡胸. 中国胸心血管外科临床杂志, 2013, 20(5): 555-559.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally invasive sternal depression by autologous force for pectus carinatum repair

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