Surgycal treatment of the Pectus Excavatum in children

Abstract

Nuss repair of funnel chests is used increasingly, but has a high bar dislocation rate. The authors intended to reduce this by technical modifications of the original Nuss technique. Methods: In 350 patients from 6 to 17 years of age (mean, 12.4 ± 3.8) were operated by Nuss procedure at the Filatov Children’s Hospital in Moscow for the last 10 years. 37% of patients had Sindromalny pathology. Operation technique: The bars were placed from left to right with use of specially metal conductor; introduced of the T-shaped titanic plate; fixing of both ends of a plate. Plate was removed in 4 years after surgery. Results. Duration of operation averaged 38±7 minutes. Terms of hospitalization averaged 8,5±2 days. Thoracoscopy was used only at 8 (2,2%) patients. From them 4 patients were previous operated by Paltia plate repair, at 3(0,8%) patients – after sternotomiya for correction of CHA and 1 patient after a pulmonectomiya. Simultanny operations were done in 4 (1,1%) patients: Thoracoscopycal ductus arteriosus repair - 2 patients, Thoracoscopycal resection of a lung - 2 patients. Complications: pheumothorax – 2(0,5%), gemathorax– 2(0,5%), plate shift – 1(0,2%) patient. One patient observed hyper correction of the chest. In 98% we had the excellent cosmetic and functional result. Residual deformation was observed - 7 (2%) patients. All patients were reoperated with excellent results. Conclusion. The modified technique more safely and has reduced the incidence of bar dislocation.