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PURPOSE: The current standard method for pectus excavatum (PE) repair is the Nuss procedure. One major postoperative complication is the displacement of the implanted metal bar, which is used to remodel the chest wall. Blocking the possible ways that the bar can be displaced with the use of stabilizers and peri/intracostal sutures has reduced the incidence of bar displacement. Despite the modifications, bar dislocation is often reported. We adopted the medial position stabilizer placement method and imposed no postoperative restrictions. In this study, we analyzed the bar dislocation rate with this modification and concurrent postoperative full activity. METHODS: Nuss procedure modification where stabilizers are placed bilaterally in the medial location was done on patients irrespective of age and Haller index greater than 3.25. A single bar was used for all patients. Cryoanalgesia was performed on every patient. No postoperative restrictions were imposed on the patients. Full immediate activities, including sports, were allowed. RESULTS: 114 patients (103 male, 11 female) were analyzed from 2016 to 2023. The median age was 15 years old. There was zero incidence of bar displacement. The combined incidence of other postoperative complications was 4%: 2 wound infections and 2 hematoma formations, both needing incision and drainage. CONCLUSION: Bilateral medial stabilizer placement resulted in no incidence of bar dislocation. Return to immediate full activities after the Nuss procedure did not appear to increase the incidence of bar displacement if stabilizers were placed medially.

Objective To explore the effectiveness and safety of enhanced recovery after surgery (ERAS) strategies on postoperative recovery for funnel chest children undergoing Nuss procedure. Methods A total of 99 children undergoing elective Nuss procedure were randomized into two groups of ERAS (n=50) and control (n=49). The strategies of ERAS group included preoperative education, breathing exercises, shortening preoperative water fasting time, multimodal analgesia, depth of anesthesia monitoring, lung-protective ventilation and prevention of postoperative nausea & vomiting. Control group fasted for 6 h, only took intravenous opioids for analgesia, no lung protective ventilation and there was no dosing of preventive antiemetic. Postoperative pain score, opioid-related adverse events (constipation, nausea & vomiting), incidence of pulmonary complications, length of hospitalization, laboratory tests (C-reactive protein, white blood cell count & neutrophil proportion) and other outcome parameters were compared between two groups. Results At postoperative 1/6 h, numerical rating scale (NRS) scores were 3.0(1.8,5.0) and 3.5(3.0,5.0) in ERAS group. Both were significantly lower than that in control group (4.0[3.0,5.0] and 4.0[3.0,6.0]) (P<0.05). Cumulative usage of PCA was 41.5(30.8,52.3) ml and it was significantly lower than 57.9(43.0,74.0) ml in control group (P<0.05). Twelve cases (12/50,24%) developed adverse events related to postoperative analgesia. It was significantly lower than 18 cases (18/49,36.7%) in control group (P<0.05). No significant inter-group difference existed in NRS scores at postoperative 12/24/48 h, the incidence of postoperative pulmonary complications, length of hospitalization, total expense or postoperative blood tests (all P>0.05). Conclusions Both safe and effective for children undergoing NUSS procedure, ERAS strategies may reduce postoperative pain score and usage of opioid within postoperative 6 h and lower the incidence of analgesic-related adverse events. However, there is insufficient evidence of ERAS on shortening length of hospitalization and lowering the incidence of postoperative pulmonary complications. [ABSTRACT FROM AUTHOR]

Pectus excavatum, the most frequent malformation of the chest wall, has been related to cardiac compression and exercise intolerance. Cardiac outcomes after minimally invasive repair of pectus excavatum with retrosternal implants, particularly after removal (> 2 years postoperative) are generally unknown. We evaluated stress echocardiography outcomes before repair and after bar removal. This study comprised a retrospective cohort of patients with diagnosis of isolated pectus excavatum who underwent stress echocardiography before minimally invasive repair with retrosternal implants, and after bar removal. The diastolic function was evaluated by means of the trans tricuspid flow and tissue doppler imaging. The compression of the atrioventricular groove was assessed using the trans tricuspid gradient and the tricuspid area. We included 43 patients, with a mean age of 15.7 ± 4.0 years (91% male). After bar removal, 83% of patients referred improvement of exercise capacity. Furthermore, we found a significant improvement in right ventricular filling patterns, including a better E/A ratio profile during exercise (p = 0.001), lower filling pressures both at rest (p < 0.0001) and during exercise (p = 0.031), and lower rates of resting paradoxical septal motion [70% vs. 20%, p = 0.0007]. The trans tricuspid mean gradient during exercise was significantly lower after bar removal (p < 0.0001). In this study involving patients with minimally invasive repair of pectus excavatum, we demonstrated a beneficial impact of such intervention after bar removal, with significant improvements related to the right ventricular function, as well as signs of relief of cardiac compression. [ABSTRACT FROM AUTHOR]

Background / Objective. The Nuss procedure effectively addresses Pectus Excavatum through minimally invasive, semi-permanent insertion of metal bars, aiming to diminish the deformity and reshape the growing thorax contour. This study aims to analyze and summarize large-scale healthcare data on characteristics of complications in patients undergoing surgical correction for chest deformities, treated with the Nuss technique. Methods. A systematic review of scientific literature was performed utilizing PubMed, with the selection criteria focused on publications detailing the diagnosis and surgical treatment of Pectus Excavatum. The systematic review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews. Results. According to established criteria, 404 publications were identified, of which 100 were deemed suitable to proceed with further analysis of the entire text. For the final analysis, we selected 27 articles. The patient sample size was 2,401. The average age of patients was 14.54 (ranging from 18 months to 51 years). Of all patients, distribution by gender was as follows: 511 females and 1,890 males. A total of 61 categories of complications were identified, totalling 850 complications. Intraoperative complications accounted for 1.29%, while postoperative complications accounted for 98.71%. The most common complications were pneumothorax (29.91%), displacement of the steel bar (11.32%), and pleural effusion (9.65%). Only 6 articles provided data on chest drainage, which was required for a total of 398 patients. The average hospitalization duration across all articles is approximately 7.5 days. Conclusions. While the Nuss technique effectively corrects deformities in Pectus Excavatum, postoperative complications like pneumothorax and steel bar displacement remain common. This underscores the need for meticulous patient selection and postoperative care to enhance safety and improve surgical outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Perioperative hypoxemia is common during minimally invasive repair of pectus excavatum (MIRPE). Oxygen Reserve Index (ORI™) is a noninvasive method that shows blood oxygenation status. In addition, this method provides information about hypoxemia earlier than pulse oximetry. The primary aim of this study was to examine the value of ORI monitoring as an early predictor of hypoxemia during surgery. The secondary aim was to evaluate the value of ORI monitoring as a guide for oxygen titration to prevent hyperoxemia. METHODS: This randomized controlled study enrolled 128 pediatric patients aged 8-18 years scheduled for elective MIRPE surgery. Patients were followed up with continuous peripheral oxygen saturation (SpO2) measurement in the control group (Group C) and continuous ORI monitoring in the study group (Group O). After pneumothorax, a decrease of 1% in basal SpO2 and 0.05 from basal ORI was considered clinically significant. Patient demographics, pre-induction, pre-first and second pneumothorax, and postoperative ORI, mean arterial pressure, temperature, perfusion index, end-tidal carbon dioxide values, length of hospital stay, anesthesia, and surgery durations were recorded. RESULTS: Desaturation time was 59.46±15.57 seconds in Group O based on ORI, and 177.64±20.94 seconds in Group C according to SpO2, and the difference was significant (p<0.001). Use of FiO2>0.6 was lower in Group O, compared with Group C (p<0.05). Length of hospital stay was lower in Group O (p=0.002). CONCLUSION: ORI may detect hypoxemia earlier than SpO2 monitoring during MIRPE surgery. ORI monitorization decreases exposure time to high oxygen concentrations and may increase patient safety during MIRPE surgery in pediatric patients. [ABSTRACT FROM AUTHOR]

An inherent defect of the sternum and ribs results in the formation of a funnel-shaped anterior chest wall. The gold standard of surgical correction is the minimally invasive Nuss procedure, which might cause severe pain and carries the risk of sensory disturbances and chronic discomfort. Integrating cryoanalgesia with standard multimodal analgesia improves the outcomes of this procedure. Based on histological results, it was hypothesised that the time of cryo-application can be reduced from the current standard period of two minutes. The goal of this study was to evaluate the efficacy of a one-minute application compared with the routine two-minute method in the same patient, considering the subjective perception of pain and sensory disturbances. A total of 33 patients were included in this prospective study. The results show that the assessment of pain severity and sensory disturbances did not differ significantly in terms of the time of cryo-application during first 14 days after the surgical procedure. The one-minute cryo-application time for intraoperative intercostal nerve cryoablation prior to the Nuss procedure seems to be as safe and effective as the routinely used two-minute application time in regards to pain severity, sensory disturbances, and the risk of chronic pain development. Intercostal nerve cryoanalgesia is an essential element of multimodal analgesia. [ABSTRACT FROM AUTHOR]

Objective: The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE. Methods: A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients’ HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits. Results: In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, P

Klippel-Feil syndrome, characterized by congenital fusion of any 2 or more cervical vertebrae, is a rare disorder in which skeletal and other organ system–related abnormalities have been reported. This article reports a case of mitral valve regurgitation in a patient with Klippel-Feil syndrome and related thoracic deformity who underwent mitral valvuloplasty. Postoperatively, the mitral valve regurgitation disappeared, and there has been no recurrence for 3 years. This case highlights mitral valvuloplasty via median sternotomy as an excellent treatment for mitral valve regurgitation in a patient with thoracic deformity related to Klippel-Feil syndrome.

Background: Recent data highlight the internet's pivotal role as the primary information source for patients. In this study, we emulate a patient's/caregiver's quest for online information concerning chest deformities and assess the quality of available information. Methods: We conducted an internet search using combination of the terms "pectus excavatum," "pectus excavatum surgery," "funnel chest," "pectus excavatum repair" and identified the first 100 relevant websites from the three most popular search engines: Google, Yahoo, and Bing. These websites were evaluated using the modified Ensuring Quality Information for Patients (EQIP) instrument. Results: Of the 300 websites generated, 140 (46.7%) were included in our evaluation after elimination of duplicates, non-English websites, and those targeting medical professionals. The EQIP scores in the final sample ranged from 8 to 32/36, with a median score of 22. Most of the evaluated websites (32.8%) originated from hospitals, yet none met all 36 EQIP criteria. Discussion: None of the evaluated websites pertaining to pectus excavatum achieved a flawless "content quality" score. The diverse array of websites potentially complicates patients' efforts to navigate toward high-quality resources. Barriers in accessing high-quality online patient information may contribute to disparities in referral, patient engagement, treatment satisfaction, and overall quality of life. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Intrathoracic intercostal cryoanalgesia (Cryo) during minimally invasive repair of pectus excavatum (MIRPE) reports have been related to improved pain management, although its extent differs amongst studies. We aimed to report our experience using a standardized perioperative approach including Cryo during MIRPE, and compare our actual results with those of a previous thoracic epidural analgesia (TE) cohort. Lessons learned are summarized. Retrospective study including patients undergoing Cryo during MIRPE between October 2018 and May 2023. Results with a standardized perioperative approach were analyzed. We then compared our Cryo cohort with a previous cohort of 62 patients who underwent TE and MIRPE between 2013 and 2018. Continuous variables were reported as mean and standard deviation, and as median (interquartile range) for variables with non-uniform distribution. We performed 176 Cryo during MIRPE (16.8 ± 4.6 years), with a mean postoperative length of stay (LOS) of 1.4 ± 0.8 days and a median total requirement of 7.5 (0.0; 15.0) oral morphine equivalents (OME) (mg). Patients with Cryo had a significantly lower mean LOS (1.4 ± 0.8 vs. 3.6 ± 1.0 days, p < 0.0001), and median total opioid requirement [7.5 (0.0; 15.0) vs. 77.4 (27.0; 115.5 OME (mg), p < 0.0001) compared to TE patients. Lessons learned included ensuring adequate contact of the cryoprobe with the target, proper exposition, and specialized multidisciplinary perioperative patient and family support, including psychology and physical therapy. In this study, we reported lessons learned after performing a standardized protocol of perioperative care in patients undergoing Cryo during MIRPE. This protocol enabled the achievement of a short LOS and low postoperative opioid requirement. Retrospective comparative study. III. • Many publications report the effectiveness of cryoanalgesia for pain management during pectus excavatum repair. • However, the extent of improvement of cryoanalgesia versus other strategies varies amongst groups whereas technical aspects are seldom described. • We report our experience with a standardized protocol and technical details of thoracoscopic intercostal cryoanalgesia in a large cohort of pectus patients. [ABSTRACT FROM AUTHOR]

IntroductionAbout 95% of congenital chest wall deformities are pectus abnormalities, with pectus excavatum (PE) being the most common. The purpose of this work is to offer a modified Taulinoplasty Technique based on 35 consecutive PE patients' 1-year single-center experience in 2022.TechniqueOne minimally invasive procedure for PE is taulinoplasty. In order to prevent invasion of the mediastinum or pleural cavity, it is considered that external traction can be used to raise the sternum. Our experience indicates that the most common surgical consequences of this procedure—which involves creating a submuscular and subcutaneous tunnel to install the metal device—are post-operative seroma and wound dehiscence. We modified the conventional method to achieve more aesthetically pleasing results.DiscussionTaulinoplasty seems to be a safe technique, easier and more feasible than standard Taulinoplasty, with better outcomes in terms of surgical complications, although further experience is necessary to confirm our preliminary data.

Thoracic surgery causes significant pain despite standard multimodal analgesia. Intraoperative cryoanalgesia may be a solution. The onset of the clinical effect of cryoanalgesia can take 12–36 h. The addition of a regional anaesthesia before the cryoanalgesia procedure can enable analgesic protection for the patient during this period. The main aim of the study was to evaluate the benefits of the erector spinae plane (ESP) block prior to Nuss surgery. The 'control' group consisted of 10 teenagers who underwent cryoablation together with intravenous multimodal analgesia according to the standard protocol. The 'intervention' group included 26 teenage patients who additionally received an erector spinae plane block before operation. Pain relief (p = 0.015), opioid use (p = 0.009), independent physical activity and rehabilitation (p = 0.020) were faster in the intervention group. No features of local anaesthetic drug toxicity or complications of the ESP block were observed. The bilateral ESP block together with intraoperative intercostal nerve cryoablation performed prior to Nuss correction of funnel chest were more effective in terms of pain control. [ABSTRACT FROM AUTHOR]

Pectus excavatum(PE) is a congenital chest deformity characterized by deep depression in the sternum. Autologous fat transplantation has been used for aesthetic purposes, mainly on the face, and has recently gained relevance in thoracic and breast surgeries. The present study aims to present a case of mild PE associated with hypomastia. A 24-year-old female patient attended the consultation for breast augmentation due to hypomastia, but the clinical examination also revealed an associated mild PE that the patient did not notice. Surgical planning included breast augmentation and autologous fat transfer. A 260ml silicone breast implant was used, and 250ml of fat was injected in the sternal region and the lower medial contour of the breasts. There were no complications during the 12-month follow-up period. The combination of augmentation mammoplasty and fat transplantation in treating PE deformity proved to be a minimally invasive, good, safe option with high patient satisfaction.

Abstract Background Pectus excavatum (PE) is the most common disease of chest wall deformity, with an incidence of 1 in 300—400 births. Nuss procedure has proved to be the best surgical treatment method and has been widely used after clinical use for 30 years. We aimed to review the clinical data of pectus excavatum (PE) of thoracoscopic Nuss procedure adopted the Modified bar bending method of the six-point seven-section type, and compare it with the traditional curved bar bending method to explore the clinical application effect. Methods Forty-six cases of clinical data were summarized of children with PE who adopted the treatment of the Modified bar bending method of the six-point seven-section type from January 2019 to December 2021, and 51 cases were compared of PE children who adopted the treatment of traditional curved bar bending method from January 2016 to December 2018, including the data of age, gender, preoperative symptoms, symmetry, Haller index, operation time, bar bending time, intraoperative bleeding, postoperative complications, bar migration, postoperative effect evaluation, etc. Results The Procedure duration (P = 0.008), bar bending time (P

Pectus excavatum (funnel chest) is the most common chest wall deformity in childhood and adolescence with a prevalence in the literature ranging from 1 in 3400 to 1 in 1000. In addition to conservative therapy with a suction cup and physiotherapy to improve posture, fitness, and muscle strength, there are several different surgical techniques, many of which have been improved over time. In evaluating the Minimalized Erlangen Correction Method (MEK), the main purpose of this retrospective analysis is to present the results and to compare them with reports on the Minimally Invasive Repair of Pectus Excavatum (MIRPE) technique, especially regarding long-term patient satisfaction, and with other open surgical methods in terms of operative trauma, as well as flexibility in its application, risk of complications, and patient safety. [ABSTRACT FROM AUTHOR]

Objective To summarize the experience of bridge technique for pectus excavatum ( PE). Methods From July 2018 to January 2021,25 PE children undergoing thoracoscopic Nuss procedure with fixation by bridge technique. There were 21 boys and 4 girls with a mean age of 172 ( 125 - 201) month. Haller index had a mean value of 4. 93(3.16 -6. 78). Severity was mild ( n =1, < 3. 2), moderate ( n =2,3. 2 -3. 5),severe (n = 18, 3. 5 -6) and extremely severe ( n =4, > 6). Results There was one case of short-term postoperative complication. Bilateral pleural effusion was relieved after puncture under B-ultrasonic positioning. Two children (8% ) had long-term complication of bridge connector nut and screw detachment. Both were of unilateral single fixator nut loss. Without bar displacement,appearance of chest wall was not affected. Loose nut was removed at the same time as bar removal. There was no recurrence. Conclusion The application of bridge technique for pectus excavatum is safe and effective, which can reduce the risk of bar displacement and achieve satisfactory correction effect. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of multimode analgesia based predominantly upon single thoracic epidural block during pediatric Nuss procedure. Methods From December 2020 to September 2021, 42 children underwent Nuss procedure. Random number table method was employed for assigning them into two groups of single thoracic epidural block plus general anesthesia ( T) and general anesthesia ( G). Group T underwent thoracic epidural block in a lateral position after tracheal intubation induced by general anesthesia. Group G was maintained by intravenous anesthesia after endotracheal intubation. After operation, both groups underwent electronic pump intravenous analgesia ( self-control + continuous administration mode). Operative duration, anesthetic time, intraoperative propofol dose, sufentanil dose, remifentanil dose and hemodynamic changes were recorded. The resting pain scores at l/6/12/24/ 48h and the timepoints of PCIA at 0 - 1 h, 1 - 6 h, 6 -12 h, 12 - 24 h and 24 -48 h post-operation were recorded. Postoperative nausea, vomiting,constipation, pain and other complications were recorded. Complications related to epidural puncture were recorded. Results lntraoperative dose of remifentanil in group T was less than that in group G (P < 0. 05 ) ; The resting pain scores of group T were lower than those of group G at 1/6/12 h post-operation ( P < 0. 05). No significant inter-group difference existed in pain scores at 24/48 h post-operation ( P > 0. 05). The frequency of patient controlled intravenous analgesia ( PCIA) at each timepoint in group T was less than that in group G ( P < 0. 05 ). The number of children with postoperative remedial analgesia was less than G( P < 0. 05) while the number of children with nausea was more than G ( P < 0. 05). No statistical difference existed in the bout of vomiting or constipation ( P > 0. 05). Epidural puncture was successful in T group without puncture related complications. Conclusion In children undergoing Nuss surgery, multi-mode analgesia based predominantly upon single thoracic epidural block may reduce the application of intravenous opioids. Its early postoperative analgesic effect is better than that of intravenous analgesia pump alone, thus improving the comfort level of children. [ABSTRACT FROM AUTHOR]