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Impact of concomitant thoracic interventions on feasibility of Nuss procedure.
J Pediatr Surg. 2007 Nov; 42(11):1853-9.JP

Abstract

BACKGROUND

This study aimed to analyze the feasibility of subsequent minimally invasive pectus repair, particularly modified Nuss procedure, combined with simultaneous thoracic procedures for different underlying intrathoracic diseases and conditions.

METHODS

A total of 110 patients, who underwent minimally invasive pectus repair in Nuss technique over a 5-year period, were retrospectively analyzed concerning complications, cosmetic results, and satisfaction. Six patients (5%) underwent the Nuss procedure with concomitant thoracic interventions. Patients with prior cardiac surgery or planned redo pectus repair were not examined and were excluded. The mean age of 6 patients (3 male and 3 female) was 11 years (range, 5.5-17.2). Two patients with former left-sided transabdominal diaphragmatic hernia repair and 1 with former lobectomy of the left lower lobe underwent thoracoscopic adhesiolysis. Two underwent thoracotomy: one for closure of a recurrent left-sided diaphragmatic hernia with fundoplication owing to a large hiatal hernia, another for lobectomy of the right middle lobe owing to recurrent infections and bronchodysplasia. One patient presented with anterior mediastinal mass, which was suspected to be benign, and underwent thoracoscopic complete resection. All patients underwent a 1-stage procedure with subsequent simultaneous Nuss procedure.

RESULTS

Simultaneous Nuss procedure was feasible without intraoperative complications in all patients (100%). Thoracoscopic adhesiolysis did not affect the feasibility of the Nuss procedure in 3 patients with former diaphragmatic hernia repair, particularly former lobectomy in one. Thoracotomy with middle-lobe lobectomy, as well as repair of recurrent diaphragmatic hernia and fundoplication in 2, did not affect modified Nuss technique and dispensed thoracoscopic guidance. Histopathologic analysis in one patient with a removed anterior mediastinal mass revealed Hodgkin lymphoma (stage IA), and the patient received multiagent chemotherapy. The postoperative course was uneventful in 5 of 6 patients. One patient required intermittent drainage of pleural effusion after simultaneous lobectomy. At follow-up (6 months-5 years), 6 patients had excellent cosmetic results and good quality of life confirmed by a questionnaire. There was no evidence of recurrent malignancy in one patient after 6 months.

CONCLUSIONS

Thoracic surgery and subsequent Nuss procedure can be performed simultaneously. Underlying conditions, such as prior repair of congenital diaphragmatic hernia or diaphragmatic eventration, as well as former lobectomy, had no impact on feasibility. Open thoracotomy can be combined with Nuss procedure dispensing thoracoscopy.

Authors+Show Affiliations

Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany. mmetzelder@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18022435

Citation

Metzelder, Martin L., et al. "Impact of Concomitant Thoracic Interventions On Feasibility of Nuss Procedure." Journal of Pediatric Surgery, vol. 42, no. 11, 2007, pp. 1853-9.
Metzelder ML, Ure BM, Leonhardt J, et al. Impact of concomitant thoracic interventions on feasibility of Nuss procedure. J Pediatr Surg. 2007;42(11):1853-9.
Metzelder, M. L., Ure, B. M., Leonhardt, J., Grigull, L., Khelif, K., & Petersen, C. (2007). Impact of concomitant thoracic interventions on feasibility of Nuss procedure. Journal of Pediatric Surgery, 42(11), 1853-9.
Metzelder ML, et al. Impact of Concomitant Thoracic Interventions On Feasibility of Nuss Procedure. J Pediatr Surg. 2007;42(11):1853-9. PubMed PMID: 18022435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of concomitant thoracic interventions on feasibility of Nuss procedure. AU - Metzelder,Martin L, AU - Ure,Benno M, AU - Leonhardt,Johannes, AU - Grigull,Lorenz, AU - Khelif,Karim, AU - Petersen,Claus, PY - 2007/11/21/pubmed PY - 2008/1/5/medline PY - 2007/11/21/entrez SP - 1853 EP - 9 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 42 IS - 11 N2 - BACKGROUND: This study aimed to analyze the feasibility of subsequent minimally invasive pectus repair, particularly modified Nuss procedure, combined with simultaneous thoracic procedures for different underlying intrathoracic diseases and conditions. METHODS: A total of 110 patients, who underwent minimally invasive pectus repair in Nuss technique over a 5-year period, were retrospectively analyzed concerning complications, cosmetic results, and satisfaction. Six patients (5%) underwent the Nuss procedure with concomitant thoracic interventions. Patients with prior cardiac surgery or planned redo pectus repair were not examined and were excluded. The mean age of 6 patients (3 male and 3 female) was 11 years (range, 5.5-17.2). Two patients with former left-sided transabdominal diaphragmatic hernia repair and 1 with former lobectomy of the left lower lobe underwent thoracoscopic adhesiolysis. Two underwent thoracotomy: one for closure of a recurrent left-sided diaphragmatic hernia with fundoplication owing to a large hiatal hernia, another for lobectomy of the right middle lobe owing to recurrent infections and bronchodysplasia. One patient presented with anterior mediastinal mass, which was suspected to be benign, and underwent thoracoscopic complete resection. All patients underwent a 1-stage procedure with subsequent simultaneous Nuss procedure. RESULTS: Simultaneous Nuss procedure was feasible without intraoperative complications in all patients (100%). Thoracoscopic adhesiolysis did not affect the feasibility of the Nuss procedure in 3 patients with former diaphragmatic hernia repair, particularly former lobectomy in one. Thoracotomy with middle-lobe lobectomy, as well as repair of recurrent diaphragmatic hernia and fundoplication in 2, did not affect modified Nuss technique and dispensed thoracoscopic guidance. Histopathologic analysis in one patient with a removed anterior mediastinal mass revealed Hodgkin lymphoma (stage IA), and the patient received multiagent chemotherapy. The postoperative course was uneventful in 5 of 6 patients. One patient required intermittent drainage of pleural effusion after simultaneous lobectomy. At follow-up (6 months-5 years), 6 patients had excellent cosmetic results and good quality of life confirmed by a questionnaire. There was no evidence of recurrent malignancy in one patient after 6 months. CONCLUSIONS: Thoracic surgery and subsequent Nuss procedure can be performed simultaneously. Underlying conditions, such as prior repair of congenital diaphragmatic hernia or diaphragmatic eventration, as well as former lobectomy, had no impact on feasibility. Open thoracotomy can be combined with Nuss procedure dispensing thoracoscopy. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/18022435/Impact_of_concomitant_thoracic_interventions_on_feasibility_of_Nuss_procedure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(07)00494-0 DB - PRIME DP - Unbound Medicine ER -