OBJECTIVE
To substantiate the problem of postoperative syndromes (PS) in children after surgery for pectus excavatum (PE) and possible approaches for its solution.
MATERIAL AND METHODS
We analyzed clinical data of 665 postoperative children with PE between 2010 and 2020. Various PS occurred in 53 (7.9%) patients who were divided into 2 groups: group 1 — 34 (64.1%) patients with PS that occurred during the wearing of fixing devices; group 2 — 19 (35.9%) patients with PS that occurred after removal of fixing devices. Atypical protrusion syndrome developed in 6 (11%) cases of the 1st group and 2 (4%) ones of the 2nd group, atypical occlusion syndrome occurred in 18 (34%) patients of the 1st group and 4 (7.5%) patients of the 2nd group, abnormal sternal rotation syndrome developed in 10 (18.9%) and 3 (5.7%) patients, respectively, recurrence of pectus excavatum — in 10 (18.9%) cases of the 2nd group.
RESULTS
We have optimized treatment of these patients using reconstructive procedures and staged corset therapy. Staged corset therapy was recommended in 8 (16%) patients with atypical sternal protrusion syndrome. Ten (18.9%) patients with abnormal sternal rotation syndrome underwent L-shaped sternal hemisternotomy with ipsilateral resection of cartilaginous parts of the ribs during removal of fixing devices. In 18 (34%) patients with atypical excavated syndrome in lateral surfaces of the chest, the sunken rib sections were mobilized by multiple chondrotomy for compliance with self-correction. Therapeutic gymnastics was recommended in 10 (18.9%) patients with PE recurrence grade I. Treatment outcomes were qualitatively evaluated as good, satisfactory and unsatisfactory. We observed favorable outcomes with adequate restoration of normal chest relief and compliance with normal anthropometric indicators in 47 (89%) out of 53 patients. Six (11%) patients had satisfactory results due to mild syndromes. These patients are being followed-up. There were no patients with severe PS and unsatisfactory results.
CONCLUSION
Postoperative syndromes are various types of cosmetic defects disfiguring normal shape of the chest. We consider the most risky age for manifestation of PS to be from 5 to 11 years (junior) and from 15 to 18 years (youth) that is associated with fast growth rate (growth spurts). It is recommended to continue wearing the plates in these age periods. Clinical manifestations of PS were pronounced in the 1st group compared to the 2nd group. The proposed treatment strategy and methods of surgical correction ensure the best cosmetic and functional results.
