RESUMO
@#Objective To summarize the experience of treating adult recurrent pectus excavatum without plate turnover. Methods Twenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation. Results All patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum. Conclusion The treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.
RESUMO
Objective To summarize the preliminary experience of surgical treatment of recurrent pectus excavatum. Methods A total of 23 cases of recurrent pectus excavatum treated in our hospital from January 2012 to December 2014 were reviewed retrospectively. Of the 23 cases, the Nuss method was employed in 15 cases, the modified Nuss method in 6 cases, the Nuss operation and osteotomy in 1 case, and the Ravitch operation in 1 case. Results The surgery was successfully completed in all the 23 patients, without serious complications. The intraoperative blood loss was 10-150 ml (median, 20 ml). The postoperative hospital stay was 4-15 days (mean, 7. 1 days). After operation, 2 cases had more drainage, which were given active thoracic drainage and nutrition. The 23 patients were given removal of steel plate at 2 years after operation, and no recurrence was seen. Conclusions The Nuss operation can be used as the first choice for patients with pectus excavatum repair failure. For patients with recurrence of severe deformity of pectus excavatum, the first choice should be the Ravitch operation.