Video thoracoscopic treatment of pectus excavatum with the minimally invasive technique nuss

Abstract

Introduction: The pectus excavatum is a mmon malformation of the anterior wall of the thorax, characterized by a depression of the sternum and impaired sternal condro joints. In most cases, congenital in origin and evolution. Reaches its greatest deformity in adolescence. For many surgical treatment techniques involving extensive resections of costal cartilages and mobilization of the sternum were used. In 1998 Donald Nuss describes a technique where video thoracoscopic introduces a sternal retro metal bar, which is inserted through a small incision on each side of the chest wall, malformation running without resection of costal cartilages or section and / or and/or sternal mobilization. Goals: To report our experience in two surgical centers, for pectus excavatum the treatment with the technique of video thoracoscopic Nuss. Work retrospective, descriptive. Materials and methods: Work retrospective, descriptive. From December 2015 to December 2019 surgically treat pectus excavatum 72 patients using the technique video thoracoscopic Nuss. Results: 63 males and 9 females. The age range at the time of surgery was 7 to 18 years (mean 15.7). Six patients older than 18 years were excluded from the sample. The average rate for Haller in this population was 4.1. All patients got a metal bar sternal retro video thoracoscopic under control, side stabilizers were placed in all patients (65 bilateral and 7 unilateral). Epidural catheter was placed for postoperative analgesic analgesia management in 100% of cases. The average operating time was 94 min. (70-110 min). Intra-operative difficulties: one bar too high had to reposition itself in the same surgical procedure, the mean average hospitalization was 9.7 days (5 -27 days). Post operative complications: The most common early complication was pneumothorax self-limiting in patients 11 (15.2%). The most severe complication was purulent pneumonia with effusion and pleural drainage needed toilette video thoracoscopy 1 (1.3%). Three patients (4.1%) had granulomas wound. Late migration of the bar that was surgically corrected with good outcome. In 65 (90%) patients, the results were very good and good; 5 (6.9%) regular and 2 (2.7%) bad due to the presence of asymmetry chest. Conclusions: Thoracoscopic technique video Nuss is safe, effective and reproducible for the treatment of patients with pectus excavatum. Parietal approach a minimum and low morbidity. The aesthetic results are very satisfactory.