Komplikasyonlar Açısından Minimal İnvaziv Onarım Pektus Karinatum İçin Hangi Dönem Seçilmeli?

Yıl 2021, , 8 - 11, 28.04.2021

Murat Akkuş , Tuba Apaydın

https://doi.org/10.35440/hutfd.754903

Öz

Amaç: Pektus karinatum (PK) çocukluk döneminde göğüsün öne çıkması ile belirir ve ergenlik döneminde daha da ilerleyebilir. Cerrahi için en uygun zaman göğüs duvarının esnek olduğu dönemdir. Bununla beraber, bugün Abramson operasyonu çocuklar ve erişkinlerde de uygulanmaktadır. Bu çalışmada, PK için çocukluk, ergenlik ve erişkin gruplar arasında Abramson operasyonun komplikasyonları açısından en uygun dönemini karşılaştırmak amaçlandı.

Materyal ve Metodlar: 2012 ile 2018 yılları arasında simetrik ve asimetrik PK 178 olgu tespit edildi. Kliniğimizde brace tedavisini kullanamayan veya başarısız olan 63 olgu Abramson cerrahisi ile tedavi edildi. Olgular 3 gruba ayrıldı: Çocukluk (12 yaşından küçük olgular), ergenlik ((13-16 yaş arasında olgular) ve erişkin (17 ve 20 yaş arasında olgular) olarak sınıflandırıldı. Hastaların demografik yapıları, cerrahi sonuçları, yatış süreleri ve komplikasyon oranları değerlendirildi.

Bulgular: Elli hasta erkek, 13 hasta kadındı. Hastaların yaş aralığı 8-20 (ortanca değer 14.5±2.5 yıl) arasında idi. Semptomatik hastalar ve göğüs ağrısı en sık olarak ileri yaş grubunda görüldü, fakat istatistiki olarak anlamlı değildi (p:0.061, p:0.901, p:510). Gruplar arasında operasyon süreleri ve takip süreleri arasında anlamlı fark izlenmedi (p:0,338, p:0,646, p:0,668). Postoperatif erken 30 günlük dönemde ölüm izlenmedi. Lojistik regresyon analizinde postoperatif komplikasyonların 17 yaş üstü grupta arttığı saptandı ancak istatistiki olarak anlamlı izlenmedi (p:0.256).

Sonuç: Abramson tekniği brace tedavisinden fayda görmeyen PK tedavisinde düşük komplikasyon oranları ile etkin ve başarılı yöntemdir. Komplikasyon oranı erişkin period da istatistiksel olarak anlamlı olmasa da artabilir.

Anahtar Kelimeler

Pektus karinatum, Abramson operasyonu, Minimal invazin onarım pektus karinatum

Which Period Should Be Chosen for Minimal Invasive Repair of Pectus Carinatum in Terms of Complications?

Öz

Background: Pectus carinatum (PC) presents with anterior protrusion of the chest wall in the childhood period and becomes more prominent during puberty. Optimum time for surgery concerns the life period with flexibility of the chest wall. However, today Abramson operation is performed for younger and adult patients by many surgeons. In this study, we aimed to compare the complication results of Abramson surgery for PC between pediatric, adolescent and adult groups, to indicate the optimal appropriate period for this surgery.
Materials and Methods: From 2012 to 2018, 178 cases had symmetric-asymmetric PC identified. A total of 63 patients who could not use or had unsuccessful outcomes with a brace therapy were treated with Abramson surgery in our clinic. We classified patients into three groups: Pediatric (patients younger than 12 years), adolescent (patients between 13 and 16 years); and adult (patients between 17 and 20 years). We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates.
Results: Fifty patients were male and 13 were female. The age range was 8 to 20 years (mean 14.5±2.5 years). Symptomatic patients and chest pain in the preoperative period were seen more frequently in patients with older age, but this was not statistically significant (p:0.061, p:0.901, p:510). There was no significant difference between groups with respect to duration of operation, and duration of follow up (p:0.338, p:0.646, p:0.668). In the early 30-day postoperative period, no mortality was observed. In logistic regression analysis, postoperative complications increased in patients older than 17 years, but this wasn't statistically significant (p:0.256).
Conclusions: The Abramson procedure is an effective and successful method with low complication rates in the group who do not benefit from a brace for treatment of pectus carinatum. However, complication rates may increase in the adult period, though this was not statistically significant.

Anahtar Kelimeler

Pectus carinatum, Abramson procedure, Minimally invasive repair pectus carinatum

Kaynakça

• Referances
• 1. Özkaya M, Bilgin M. Minimally invasive repair of pectus carinatum by modification of the Abramson technique. Wideochir Inne Tech Maloinwazyjne. 2018;13(3):383–387. doi:10.5114/wiitm.2018.75888
• 2. Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. Journal of pediatric surgery. 1998 Apr 1;33(4):545-52. Doi: 10.1016/s0022-3468(98)90314-1
• 3. -Abramson H. A minimally invasive technique to repair pectus carinatum. Preliminary report. Archivos de Bronconeumología ((English Edition)). 2005 Jun 1;41(6):349-51.Doi: 10.1016/s1579-2129(06)60235-8.
• 4. Yuksel M, Lacin T, Ermerak NO, Sirzai EY, Sayan B. Minimally invasive repair of pectus carinatum. The Annals of thoracic surgery. 2018 Mar 1;105(3):915-23. Doi: 10.1016/j.athoracsur.2017.10.003.
• 5. Bilgin M, Oral A. Early results of minimal invasive surgery in patients with pectus carinatum. Turk Gogus Kalp Damar 2012;20:307-311. doi 10.5606/tgkdc.dergisi.2012.058
• 6. Ravitch MM. Operative correction of pectus carinatum (pigeon breast). Annals of surgery. 1960 May;151(5):705. Doi: 10.1097/00000658-196005000-00011
• 7. Kravarusic D, Dicken BJ, Dewar R, Harder J, Poncet P, Schneider M, Sigalet DL. The Calgary protocol for bracing of pectus carinatum: a preliminary report. Journal of pediatric surgery. 2006 May 1;41(5):923-6. Doi: 10.1016/j.jpedsurg.2006.01.058
• 8. Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum. InSeminars in pediatric surgery 2008 Aug 1 (Vol. 17, No. 3, pp. 194-200). WB Saunders. Doi: 10.1016/j.athoracsur.2016.12.019
• 9. Cohee AS, Lin JR, Frantz FW, Kelly Jr RE. Staged management of pectus carinatum. Journal of pediatric surgery. 2013 Feb 1;48(2):315-20. Doi: 10.1016/j.jpedsurg.2012.11.008
• 10. Lee RT, Moorman S, Schneider M, Sigalet DL. Bracing is an effective therapy for pectus carinatum: interim results. Journal of pediatric surgery. 2013 Jan 1;48(1):184-90. Doi: 10.1016/j.jpedsurg.2012.10.037
• 11. Yüksel M, Bostanci K, Evman S. Minimally invasive repair of pectus carinatum using a newly designed bar and stabilizer: a single-institution experience. European journal of cardio-thoracic surgery. 2011 Aug 1;40(2):339-42. Doi: 10.1016/j.ejcts.2010.11.047
• 12. Abramson H, D’Agostino J, Wuscovi S (2009) A 5-year experience with a minimally invasive technique for pectus carinatum repair. J Pediatr Surg44(1):118–123. Doi: 10.1016/j.jpedsurg.2008.10.020
• 13. Abramson H, Aragone X, Blanco JB, Ciano A, Abramson L. Minimally invasive repair of pectus carinatum and how to deal with complications. J Vis Surg. 2016;2:64. Published 2016 Mar 23. doi:10.21037/jovs.2016.03.11
• 14. Suh J, Joo S, Lee GD, Haam SJ, Lee S. Minimally Invasive Repair of Pectus Carinatum in Patients Unsuited to Bracing Therapy. Korean J Thorac Cardiovasc Surg 2016;49:92-98. https://doi.org/10.5090/kjtcs.2016.49.2.92
• 15. Katrancioglu Ö, Akkas Y, Karadayi S, Sahin E, Kaptanoğlu M. Is the Abramson technique effective in pectus carinatum repair? Asian Journal of Surgery,2018;41:1,73-76,ISSN 1015-9584. https://doi.org/10.1016/j.asjsur.2016.09.008