Postoperative syndromes in children after surgery for pectus excavatum

Close metadata

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 1^st group and 2 (4%) ones of the 2^nd group, atypical occlusion syndrome occurred in 18 (34%) patients of the 1^st group and 4 (7.5%) patients of the 2^nd 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 2^nd 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 1^st group compared to the 2^nd group. The proposed treatment strategy and methods of surgical correction ensure the best cosmetic and functional results.

Keywords:

children

chest

pectus excavatum

postoperative syndromes

Authors:

Khodzhanov I.Yu.

Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics

Khakimov Sh.K.

Abu Ali ibn Sino Bukhara State Medical Institute

Received:

06.02.2022

Accepted:

04.05.2022

List of references:

Azizov MZh, et al. Comparative assessment of the results of treating pectus excavatum in children using various thoracoplastic techniques (long-term results). Genij ortopedii. 2015;3:38-44. (In Russ.). https://doi.org/10.18019/1028-4427-2015-3-38-44
Aprosimova SI, et al. Voronkoobraznaya deformatsiya grudnoj kletki u detej: otsenka kachestva zhizni do i posle operativnogo lecheniya. Vyatskij meditsinskij vestnik. 2018;3(59):4-11. (In Russ.).
Gatsutsyn VV, et al. The substantiation of the differentiated approach in diagnostics and surgical correction of the funnel-shaped deformation of the chest in children. Detskaya khirurgiya. 2018;22(4):199-204. (In Russ.). https://doi.org/10.18821/1560-9510-2018-22-4-199-204
Dzhenalaev DB, et al. Maloinvazivnaya khirurgiya v lechenii voronkoobraznoj deformatsii grudnoj kletki u detej. Materialy VI Foruma detskikh khirurgov Rossii. Rossijskij vestnik detskoj khirurgii, anesteziologii i reanimatologii. 2020;10:57. (In Russ.).
Kadyshev AV. Opyt lecheniya voronkoobraznoj deformatsii grudnoj kletki u detej. VII nauchno-prakticheskaya konferentsiya molodykh uchenykh na anglijskom yazyke «Budushchee detskoj ortopedii i rekonstruktivnoj khirurgii». Ortopediya, travmatologiya i vosstanovitel’naya khirurgiya detskogo vozrasta. 2020;8:24-26. (In Russ.).
Komolkin IA, Agranovich OE. Clinical types of chest wall deformities (literature review). Zhurnal klinicheskoj i eksperimental’noj ortopedii im. G.A. Ilizarova. 2017;23(2):241-247. (In Russ.). https://doi.org/10.18019/1028-4427-2017-23-2-241-247
Kulik IO et al. Etiologiya i patogenez voronkoobraznoj deformatsii grudnoj kletki u detej. Travmatologiya i ortopediya Rossii. 2013;2(68):136-141. (In Russ.).
Malakhov OA et al. Ortopedicheskie aspekty i osobennosti operativnogo lecheniya voronkoobraznoj deformatsii grudnoj kletki u detej i podrostkov. Meditsina Kyrgyzstana. 2011;4:182-184. (In Russ.).
Plyakin VA, et al. Sravnitel’naya otsenka operatsij Nassa i Ravicha dlya lecheniya voronkoobraznoj deformatsii grudnoj kletki. Detskaya khirurgiya. 2013;3:60-64. (In Russ.).
Razumovsky AYu, et al. 15-letnij opyt lecheniya voronkoobraznoj deformatsii grudnoj kletki u detej. Detskaya khirurgiya im. Yu.F. Isakova. 2016;20(6):284-287. (In Russ.).
Razumovsky AYu, et al. Sravnitel’naya otsenka rezul’tatov lecheniya pri razlichnykh sposobakh torakoplastiki u detej s voronkoobraznoj deformatsiej grudnoj kletki. Rossijskij vestnik detskoj khirurgii, anesteziologii i reanimatologii. 2017;7(2):7-12. (In Russ.).
Razumovsky AYu et al. Analiz perioperatsionnykh oslozhnenij pri korrektsii voronkoobraznoj deformatsii grudnoj kletki po modifitsirovannoj metodike Nassa. Detskaya khirurgiya. 2017;21(5):251-257. (In Russ.).
Savelieva MS, Razumovsky AYu. Torakoplastika po D. Nuss i ee modifikatsii v raznykh stranakh. Detskaya khirurgiya. 2014;1:34-38. (In Russ.).
Satzhanov AB et al. Surgical treatment of chest deformities. Journal of Clinical Medicine of Kazakhstan. 2017;3(45):22-24. (In Russ.). https://doi.org/10.23950/1812-2892-JCMK-00509
Sinitsa NS, et al. Khirurgicheskoe lechenie vrozhdennoj voronkoobraznoj deformatsii grudnoj kletki u detej i podrostkov v Kuzbasskom regione. Politravma. 2016;2:55-60. (In Russ.).
Smirnova NE et al. Preimushchestva radikal’nogo operativnogo lecheniya pri voronkoobraznoj deformatsii grudnoj kletki u detej. Byulleten’ VSNS SO RAMN. 2012;4(86):94-95. (In Russ.).
Stalmakhovich VN, et al. Redkie oslozhneniya posle torakoplastiki u detej s vrozhdennoj voronkoobraznoj deformatsiej grudnoj kletki. Byulleten’ VSNS SO RAMN. 2015;3(103):18-20. (In Russ.).
Starikov OV, et al. Khirurgicheskoe lechenie voronkoobraznoj deformatsii grudnoj kletki metodom Nassa. Pediatricheskij vestnik Yuzhnogo Urala. Informatsionno-analiticheskij zhurnal. 2012;1:117-118. (In Russ.).
Shamik VB, Davud BA, Frantsiyants KG. Osobennosti khirurgicheskogo lecheniya asimmetrichnykh voronkoobraznyh deformatsij grudnoj kletki u detej starshe 12 let. Meditsinskij vestnik Severnogo Kavkaza. 2012;4:35-38. (In Russ.).
Hebra A, Gauderer MW, Adamson WT. Minimally invasive repair of pectus excavatum deformity. Eur J Cardiothorac Surg. 2011;42(3):318-320.
Jacobsen EB, Thastum M, Jeppesen JH, Pilegaard HK. Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg. 2010;20(2):85-91.
Khakimov ShK, Yusupov SYu. Analisys of pectus excavatum repair results in children. European Journal of Pharmaceutical and Medical Research. 2020;7(7):963-965.
Nuss D. Outcome Analysis of Minimally Invasive Repair of Pectus Excavatum: Review of 251 Cases. J Pediatr Surg. 2000;35:252-257. https://doi.org/10.1177/000992280003900913
Redlinger RE Jr, Rushing GD, Moskowitz AD, Kelly RE Jr, Nuss D, Kuhn A, Obermeyer RJ, Goretsky MJ. Minimally invasive repair of pectus excavatum in patients with Marfan syndrome and marfanoid features. J Pediatr Surg. 2010;45(1):193-199.
Zganjer M, Cigit I, Cizmić A, Pajić A. A 3-year experience of a minimally invasive technique for correction of pectus excavatum in Croatia. Coll Antropol. 2005;29(1):107-109.

Close metadata