Muharrem ÖZKAYA, Nilay Çavuşoğlu YALÇIN, Mehmet BİLGİN

Açık cerrahi sonrası nüks eden pektus ekskavatumun Nuss işlemi ile tedavisi

Amaç: Bu yazıda Nuss işlemi ile yeniden minimal invaziv nüks eden pektus ekskavatum tamirine ilişkin deneyimimiz sunuldu. Çalışma planı: Haziran 2006 - Ocak 2016 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi ve Antalya Eğitim ve Araştırma Hastanesi’nde minimal invaziv pektus ekskavatum tamiri yapılan 130 hasta (98 erkek, 32 kadın; ort. yaş 14.6 yıl; dağılım 1-37 yıl) retrospektif olarak incelendi. Hastalar iki gruba ayrıldı. Grup 1’e primer Nuss tamiri yapılan 119 hasta alınır iken, grup 2’ye daha önce modifiye Ravitch ameliyatı başarısız olan ve nüks nedeni ile Nuss tamiri yapılan 11 hasta dahil edildi. Her iki grup arasında demografik özellikler, hastanede yatış süresi ve komplikasyonlar karşılaştırıldı. Bulgular: Medyan yaş grup 1’de 14 yıl (dağılım 1-36 yıl) ve grup 2’de 18 yıl (dağılım 9-31 yıl) idi. Toplam komplikasyon oranları grup 1 ve grup 2 için sırası ile %8.4 ve %27.3 idi. Hastanede kalış süreleri, yerleştirilen bar sayıları ve komplikasyonlar açısından iki grup arasında istatistiksel açıdan anlamlı bir fark bulunamadı. Sonuç: Nuss tamiri, öncesinde açık cerrahinin başarısız olduğu nüks eden pektus ekskavatumlu belirli hastalarda güvenli bir ameliyattır.

The treatment of recurrent pectus excavatum following open surgery through the Nuss procedure

Background: In this study, we report our experience with the redo minimally invasive recurrent pectus excavatum repair through the Nuss procedure.Methods: We retrospectively reviewed 130 patients (98 males, 32 females; mean age 14.6 years; range 1 to 37 years) who underwent minimally invasive repair of pectus excavatum at Erciyes University, Medical Faculty, and Antalya Training and Research Hospital between June 2006 and January 2016. The patients were divided into two groups. Group 1 included 119 patients who underwent primary Nuss repair, whereas group 2 included 11 patients who underwent the Nuss repair for recurrence following an unsuccessful modified Ravitch operation. Demographic characteristics, length of hospital stay, and complications in both groups were compared.Results: The median age was 14 years (range 1 to 36 years) in group 1 and 18 years (range 9 to 31 years) in group 2. Overall complication rates were 8.4% and 27. 3% in group 1 and group 2, respectively. There was no statistically significant difference in the length of hospital stay, number of bars placed, and complications between the two groups.Conclusion: Nuss repair is a safe operation in selected recurrent pectus excavatum patients with a previously failed open repair.

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20. Bilgin M, Fazlıoğlu M, Oral A. Pectus excavatum: Nuss experience in 110 cases. Turk Gogus Kalp Dama 2014;22:790-4.
19. Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience. J Thorac Dis 2015;7:172-6.
18. Castellani C, Saxena AK, Zebedin D, Hoellwarth ME. Pleural and pericardial morbidity after minimal access repair of pectus excavatum. Langenbecks Arch Surg 2009;394:717-21.
17. Nuss D, Croitoru DP, Kelly RE Jr, Goretsky MJ, Nuss KJ, Gustin TS. Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 2002;12:230-4.
16. Demirkaya A, Şimşek F, Erşen E, Aksoy B, Sayılgan C, Turna A, et al. The factors determining the complications in the minimally invasive surgical correction of pectus excavatum. Turk Gogus Kalp Dama 2011;19:201-6.
15. Hebra A, Swoveland B, Egbert M, Tagge EP, Georgeson K, Othersen HB Jr, et al. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg 2000;35:252 -7.
14. Boehm RA, Muensterer OJ, Till H. Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children. Plast Reconstr Surg 2004;114:668-73.
13. Sauerbruch F. Operative Beseitigung der angeborenen Trichterbrust. Deutsche Zeitschrift Für Chirurgie 1931;234:760-4.
12. Dzielicki J, Korlacki W, Janicka I, Dzielicka E. Difficulties and limitations in minimally invasive repair of pectus excavatum--6 years experiences with Nuss technique. Eur J Cardiothorac Surg 2006;30:801- 4.
11. Nuss D, Kelly RE Jr. Minimally invasive surgical correction of chest wall deformities in children (Nuss procedure). Adv Pediatr 2008;55:395-410.
10. Krasopoulos G, Dusmet M, Ladas G, Goldstraw P. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Eur J Cardiothorac Surg 2006;29:1-5.
9. Nuss D. Minimally invasive surgical repair of pectus excavatum. Semin Pediatr Surg 2008;17:209-17.
8. Antonoff MB, Saltzman DA, Hess DJ, Acton RD. Retrospective review of reoperative pectus excavatum repairs.J Pediatr Surg 2010;45:200-5.
7. Redlinger RE Jr, Kelly RE Jr, Nuss D, Kuhn MA, Obermeyer RJ, Goretsky MJ. One hundred patients with recurrent pectus excavatum repaired via the minimally invasive Nuss technique--effective in most regardless of initial operative approach. J Pediatr Surg 2011;46:1177-81.
6. Kelly RE, Goretsky MJ, Obermeyer R, Kuhn MA, Redlinger R, Haney TS, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg 2010;252:1072-81.
5. Nuss D, Kelly RE Jr, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998;33:545-52.
4. Welch KJ. Satisfactory surgical correction of pectus excavatum deformity in childhood; a limited opportunity. J Thorac Surg 1958;36:697-713.
3. Ravitch MM. The Operative Treatment of Pectus Excavatum. Ann Surg 1949;129:429-44.
2. Goretsky MJ, Kelly RE Jr, Croitoru D, Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin 2004;15:455-71.
1. Kelly RE Jr, Lawson ML, Paidas CN, Hruban RH. Pectus excavatum in a 112-year autopsy series: anatomic findings and the effect on survival. J Pediatr Surg 2005;40:1275-8.