Akademik Veri Yönetim Sistemi
2022 Chest Wall International Group (CWIG) Annual Meeting, Barcelona, İspanya, 14 - 16 Eylül 2022, ss.1
INTRODUCTION: Minimally invasive methods are the first choice for surgical repair of chest wall deformities. In this way, through to the Nuss Procedure described by Donald Nuss in 1987 and the Abramson procedure described by Abramson in 2005, surgical correction of many chest wall deformities was performed. Unfortunately, some cases aren’t very suitable for the minimally invasive method. The demand for open surgical procedures still continues, especially in mixed type chest wall deformities. In this study, we aimed to talk about and our clinical experience and our patients who underwent open surgery due to chest deformity in our clinic.
METHODS: Between 2011 and 2021, 34 patients who underwent open surgery were evaluated in terms of age, gender, type of chest wall deformity, surgical procedure performed, number of incisions, number of ribs excised, whether instrumentation was applied, hospitalization time and recurrence.
RESULTS: Twenty four of the cases were male and 10 were female (mean age 20.14 years, 12-45, med 20). 18 of them have pectus carinatum and 16 of them have mixed type chest deformity. Only open surgery was performed in 23 patients, 10 underwent open surgery and Nuss, and 1 underwent open surgery and Abramson. Nuss operation was previously performed in 6 of the patients who had only open surgery. The reason for the need for a second surgery after Nuss in these patients was the development of ovarian reduction. The number of incisions varied between 1-3, depending on the surgical procedure performed. 19 bars, two for two patient and one for 15 patients, were inserted. Wedge resection of the sternum was performed in 19 patients, and 10 of these patients had a mixed type and 9 had a pectus carinatum chest deformity. Partial rib resection was performed in 32 patients . Two patients who did not undergo rib resection were patients with mixed-type chest deformity who underwent Nuss+ wedge resection of the sternum. The mean hospitalization time was 4.22 days (med:4, 2-10 days). Except for one case, all cases were followed without drains in the postoperative period. Pneumothorax was observed in 3 patients as a postoperative complication. Patients were evaluated with a satisfaction questionnaire in the postoperative period. Patients who were asked to score between 1 and 5 for their satisfaction with the final image of the chest wall gave mean 4.5 points.
CONCLUSIONS: Although there are minimally invasive procedures such as Nuss and Abramson in the surgical treatment of chest wall deformities, open surgery is still a preferable procedure in cases with asymmetric or mixed chest wall deformities. In our clinic, we prefer open surgery or combined treatments for deformities above the nipple. There is no difference in the hospitalization period compared to minimally invasive surgeries, and excellent results can be obtained with open surgery. As a result, the selection and implementation of the most appropriate procedure with the appropriate equipment and experienced surgical team is of great importance in order to ensure patient satisfaction.
KEY WORDS: Pectus Carinatum, Ravitch, Pectus Excavatum