In 1998, D. Nuss described a minimally invasive procedure for surgical repair of Pectus excavatum. The Nuss procedure is still considered as the “gold standard”, and has experienced numerous modifications such as routine thoracoscopy and/or sternal elevation, increasing safety of the procedure. Placement of multiple bars and the so called cross-bar technique were introduced to correct complex chest wall deformities. Standardized pain management, cryo-analgesia and standardized postop PT programs including deep breathing exercises facilitate the establishment of an enhanced recovery process. Widespread use of the minimally invasive repair of pectus excavatum procedure has been associated with some serious complications (w/ bar placement and removal).
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Current developments in minimally invasive repair of pectus excavatum should include the routine use of thoracoscopy as well as intraoperative sternal (breast bone) elevation technique to improve the safety of the procedure and to avoid near-fatal complications such as cardiac injury. The majority of pectus surgeons perform the procedure in adolescent #pectusexcavatum patients with a median age of 15 yrs. Preop assessment should include allergy testing, in particular in #pectus patients with personal or family history of metal allergy. Individualized surgical repair is mandatory for pectus excavatum patients presenting with complex chest wall deformities. With concomitant bilateral costal flaring and/or depression of the lower part of the chest wall, cross-bar insertion technique is recommended for surgical repair in order to achieve excellent cosmetic results #pectus #chestwalldeformity
13 ноя 2023
