Nuss prosedürü ile takılan barların çıkarılması kolay mıdır?

Yıl 2018, Cilt: 2 Sayı: 2, 87 - 90, 01.05.2018

Özgür Katrancıoğlu , Yücel Akkaş Ekber Şahin Şule Karadayı Melih Kaptanoğlu Tuba Şahinoğlu Nurkay Katrancıoğlu

https://doi.org/10.28982/josam.399825

Öz

Amaç: Pektus Ekskavatum (PE)’un minimal invaziv yöntemle onarımı 1998’den beri popüler hale gelmiştir. Deformiteyi kaldırmak için substernal alana konveks şekil verilmiş bar yerleştirilir ve yaklaşık 24-36 ay arası kalır. Bu barların bazılarının çıkarılması esnasında zorluklarla karşılaştık. Bu nedenle çalışmamızda karşılaştığımız zorlukları sunmak istedik. 

Yöntemler: Haziran 2011 ile Mart 2017 tarihleri arasında kliniğimizde barları çıkarılan 39 hastanın verileri retrospektif olarak incelendi ve 9 hastada bar çıkarılması esnasında zorluk tespit edildi.   Hastalar cinsiyet, yaş, barın vücutta kalma süresi, hastanede yatış süreleri, morbidite ve mortaliteleri açısından değerlendirildi.

Bulgular: Ortalama hasta yaşı 24,1 (en küçük 19, en büyük 36) idi. Pektus barların ortalama kalış süresi 35,5 (en kısa 34, en uzun 38) aydı. Zorluk olmayan grupta ortalama ameliyat süresi 50 dakika iken, zorluk olan grupta 90 dakika idi. Zorluk sebepleri sıklıkla fibrozis, ossifikasyon ve barın intratorasik bölgeye yer değiştirmesi idi. 

Sonuç: PE nedeniyle takılan barların çıkarılmasında dikkatli ve multidisipliner yaklaşım önemlidir.  Görülen zorluklar zamanla kazanılan deneyimle aşılabilir.

Anahtar Kelimeler

Pektus ekskavatum, Nuss prosedürü, Bar çıkarılması

Is it easy to remove the bar fitted with Nuss procedure?

Öz

Aim: Minimally invasive repair for pectus excavatum (PE) has become a popular approach since 1998. Convex bar is place into the substernal position to leverage the deformity and left for approximately 24 to 36 months. We have noticed difficulties during some of these bars at removal. So we presented difficulties during the bar removal in this study.

Methods: The medical files of 39 patients who removal of the bars at our clinic between June 2011 and March 2017 were reviewed retrospectively. The medical files were reviewed retrospectively and 9 cases involving difficulty removed the bar were included in this study. Patients were evaluated in terms of gender, age, the bar duration time on the body, duration of hospital stay, morbidity and mortality.

Results: Mean patients age was 24.1 (range, smallest 19 and greatest 36) years. The overall mean duration of pectus bar maintenance was 35.5 (range, minimum 34 and maximum 38) months. While the mean duration of surgery was 50 minutes (range 38-52) in the non-difficulty group, the mean duration was 90 (range 74-110) minutes in the difficulty group. The causes of difficulties are mostly fibrosis, ossification and displacement of the intrathoracic region.

Conclusion: Careful attention and multidisciplinary work are important for the removal of bars attached due to PE. Emerging difficulties can be overcome with the experience gained over time.

Anahtar Kelimeler

Pectus excavatum, Nuss procedure, Bar removal

Kaynakça

• 1. Nuss D, Kelly Jr RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998;33:545-52.
• 2. Noguchi M, Fujita K. A new technique for removing the pectus bar used in the Nuss procedure. J Pediatr Surg. 2005;40:674–7.
• 3. Miller KA, Woods RK, Sharp RJ, et al: Minimally invasive repair of pectus excavatum: A single institution’s experience. Surgery. 2001;130: 652-7.
• 4. Hebra A, Swoveland B, Egbert M, et al: Outcome analysis of minimally invasive repair of pectus excavatum: Review of 251 cases. J Pediatr Surg. 2000;35:252-7.
• 5. Ostlie DJ, Marosky JK, Spilde TL, Snyder CL, St Peter SD, Gittes GK, Sharp RJ. Evaluation of Pectus Bar Position and Osseous Bone Formation. J Pediatr Surg. 2003;38:953-6.
• 6. Bilgi Z, Ermerak N.O, Laçin T, Bostancı K, Yüksel M. Previously Complicated Nuss Procedure Does Not Preclude Blind Removal of the Bar. Thorac Cardiovasc Surg. 2016;64:83–6.
• 7. Fallon SC, Slater BJ, Nuchtern JG, et al. Complications related to the Nuss procedure: minimizing risk with operative technique. J Pediatr Surg. 2013;48(5):1044–8.
• 8. Liu W, Kong D, Yu F, Yin B. A simple technique for pectus bar removal using a modified Nuss procedure. J Pediatr Surg. 2013;48:1137–41.
• 9. Schon R, Schmelzeisen R, Shirota T, et al: Tissue reaction around miniplates used for the fixation of vascularized iliac crest bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83:433-40.
• 10. Giacomo T.D, Diso D, Francioni F, Anile M, Venuta M. Minimally invasive pectus excavatum repair: migration of bar and ossification. Asian Cardiovascular & Thoracic Annals. 2012;21: 88–9.
• 11. Nuss D. Minimally invasive surgical repair of pectus excavatum [Review]. Semin Pediatr Surg. 2008;17:209–17.
• 12. Vegunta RK, Pacheco PE, Wallace LJ, Pearl RH. Complications associated with the Nuss procedure: continued evolution of the learning curve. Am J Surg. 2008;195:313–7.
• 13. Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg. 2004;39:391–5.
• 14. Morimoto K, Imai K, Yamada A, Fujimoto T, Matsumoto H, Niizuma K. Migration of pectus bar into the ribs. J Plast Reconstr Aesthet Surg. 2008;61:225–7.
• 15. Jemielity M, Pawlak K, Piwkowski C, Dyszkiewicz W. Life-threatening aortic hemorrhage during pectus bar removal. Ann Thorac Surg. 2011;91(2):593–5.
• 16. Haecker FM, Berberich T, Mayr J, Gambazzi F. Near-fatal bleeding after transmyocardial ventricle lesion during removal of the pectus bar after the Nuss procedure. J Thorac Cardiovasc Surg. 2009;138(5):1240–1.