COMPARATIVE ESTIMATION OF TREATMENT RESULTS IN DIFFERENT METHODS OF THORACOPLASTY IN CHILDREN WITH PECTUS EXCAVATUM

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  • Authors: Razumovsky A.Y.1,2, Alkhasov A.B.3, Mitupov Z.B.3, Dallakyan D.N.4, Savelieva M.S.1,2
  • Affiliations:
    1. N.I. Pirogov Russian National Research Medical University
    2. N.F. Filatov Children’s Municipal Clinical Hospital No. 13
    3. "Sourb Astvatsamayr" mc
  • Issue: Vol 7, No 2 (2017)
  • Pages: 7-12
  • Section: ORIGINAL ARTICLES
  • URL: https://rps-journal.ru/jour/article/view/347
  • DOI: https://doi.org/10.30946/psaic347

Abstract


The purpose of the study: to compare the results of treatment of  patients with pectus excavatum in different methods of thoracoplasty in children

Materials and methods: 542 patients with pectus excavatum were  operated from 1996 to 2016. For the purpose of comparative  estimation, the patients operated using various methods were  divided into two groups. The first group included 90 children who  underwent surgery using the method of Salamaa-Paltia. The second  group embraced 452 patients using the Nass procedure of modified  thoracoplasty. The following parameters were estimated and  compared for the groups: surgery duration, length of epidural  anesthesia, duration of anesthetics intake, intra- and postoperative complications, number of days spent at the hospital following the surgery. 

Results: no epidural anesthesia was given to the patients from the  1st group. The children who underwent a surgery received narcotic  analgesics combined with non-steroid anti-inflammatory agents  prospectively. The protocol of postoperative analgesia of the 2nd  group included prolonged epidural anesthesia combined with non- steroid anti- inflammatory agents. Narcotic analgesics were used  only when the above mentioned agents failed to stop the pain  syndrome. Thoracoscopy was performed in 9 (1.9%) of patients. Simultaneous surgeries were done in 10 (2.2%) patients. Groups I  and II have significant differences as related to the time of an  operation and intraoperative blood loss. The surgery duration using  the Salmaa-Paltia procedure 2.7 times exceeded the length of  thoracoplasty using the modified Nass procedure; intraoperative blood loss was 4 times as much.

 

Conclusions: the modified Nass procedure to correct the pectus  excavatum is safe and effective in most cases including syndrome- based forms of the disease and enables to obtain an excellent  cosmetic result. It reduces the risk of such complications as damage  to the chest organs during a surgery and displacement of the plate  during the postoperative period.


About the authors

A. Yu. Razumovsky

N.I. Pirogov Russian National Research Medical University;

Email: fake@neicon.ru

Russian Federation

Доктор медицинских наук, проф., зав. кафедрой детской хирургии РНИМУ им. Н.  И. Пирогова. Заведующий отделением торакальной хирургии ДГКБ № 13 им. Н. Ф. Филатова

A. B. Alkhasov

N.F. Filatov Children’s Municipal Clinical Hospital No. 13

Email: fake@neicon.ru

Russian Federation Доктор медицинских наук, проф., врач – торакальный хирург, ДГКБ № 13

Z. B. Mitupov

N.F. Filatov Children’s Municipal Clinical Hospital No. 13

Email: fake@neicon.ru

Russian Federation

Доктор медицинских наук, доц., врач – торакальный хирург, ДГКБ № 13 им. Н. Ф. Филатова

D. N. Dallakyan

"Sourb Astvatsamayr" mc

Author for correspondence.
Email: ddallakyan@yahoo.com

Armenia Yerevan

M. S. Savelieva

N.I. Pirogov Russian National Research Medical University;

Email: fake@neicon.ru

Russian Federation Аспирант кафедры детской хирургии РНИМУ им. Н. И. Пирогова

References

  1. Разумовский А.Ю., Павлов А.А., Алхасов А.Б., Гаджимирзаев Г.Г., Рачков В.Е., Кулешов Б.В. Хирургическая коррекция воронкообразной деформации грудной клетки методом Насса. Детская хирургия. 2006. № 2. С. 4–9. Razumovskij A. Ju., Pavlov A. A., Alhasov A. B., Gadzhimirzaev G. G., Rachkov V. E., Kuleshov B. V. i dr. Hirurgicheskaja korrekcija voronkoobraznoj deformacii grudnoj kletki metodom Nassa // Detskaja hirurgija. 2006. № 2. S. 4–9.
  2. Castellani C., Schalamon J., Saxena A. K., Hoellwarth M. E. Early complications of the Nuss procedure for the pectusexcavatum: a prospective study // Pediatr. Surg. Int. 2008;24:659– 666.10.1007/s00383‑008‑2106‑z.
  3. Zhang D. K., Tang J. M., Ben X. S., Xie L., Zhou H. Y., Ye X., Zhou Z. H., Shi R. Q., Xiao P., Chen G. Surgical correction of 639 pectusexcavatum cases via the Nuss procedure // J ThoracDis. 2015 Sep;7 (9):1595–605. doi: 10.3978/j2072–1439.2015.09.30.
  4. Hebra A., Swoveland B., Egbert M., Tagge E. P., Georgeson K., Othersen H. B., Nuss D. Outcome analysis of minimally invasive repair of pectusexcavatum: review of 251 cases // J PediatrSurg 2000; 35:252–257.10.1016/S0022–3468 (00) 90019–8.
  5. Johnson W. R., Fedor D., Singhal S. A novel approach to eliminate cardiac perforation in the Nuss procedure // Ann ThoracSurg 2013; 95:1109–1111.
  6. Kim D., Idowu O., Palmer B., Kim S. Anterior chest wall elevation using a T-fastener suture technique during a Nuss procedure // Ann ThoracSurg 2014; 98: 734–736.
  7. Moss R. L., Albanese C. T., Reynolds M. Major complications after minimally invasive repair of pectusexcavatum: case reports // J PediatrSurg 2001; 36:155–158.
  8. Nuss D., Kelly R. E. Jr., Croitoru D. P., Katz M. E. A 10‑year review of a minimally invasive technique for the correction of pectusexcavatum // J. Pediatr. Surg. 1998;33:545–552.
  9. Krasopoulos G., Dusmet M., Ladas G., Goldstraw P. Nuss procedure improves the quality of life in young maleadults with pectusexcavatum deformity // European Journal of Cardio- thoracic Surgery. 2006; 29:1–5.
  10. Johnson W.R., Fedor D. and Singhal S. Systematic review of surgical treatment techniques for adult and pediatric patients with pectusexcavatum Johnson et al. // Journal of Cardiothoracic Surgery 2014, 9:25.
  11. Papic J. C., Finnell S. M., Howenstein A. M., Breckler F., Leys C. M. Postoperative opioid analgesic use after Nuss versus Ravitch pectusexcavatum repair // J Pediatr Surg. 2014 Jun;49 (6):919–23.
  12. Lam M. W., Klassen A. F., Montgomery C. J., LeBlanc J. G., Skarsgard E. D. Quality-of-life outcomes after surgical correction of pectusexcavatum: a comparison of the Ravitch and Nuss procedures // J Pediatr Surg. 2008. May;43 (5):819–25.
  13. Nasr A., Fecteau A., Wales P. W. Comparison of the Nuss and the Ravitch procedure for pectusexcavatum repair: a metaanalysis // J Pediatr Surg. 2010 May;45 (5):880–6.
  14. Kang C. H., Park S., Park I. K., Kim Y. T., Kim J. H. Long-term Surveillance Comparing Satisfaction between the Early Experience of Nuss Procedure vs. Ravitch Procedure // Korean J ThoracCardiovasc Surg. 2012 Oct;45 (5):308–15.

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