Publication: ‘Short Bars Crossed’ to Remodel the Entire Chest Wall in Children and Adolescents with Pectus Excavatum
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Date
2024-01-01
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Abstract
Background: The cross-bar technique of minimally invasive pectus excavatum (PE) correction remains underreported, which is especially true of pediatric patients. We therefore reviewed the experience of a Turkish and an Austrian center. An additional novelty characterizing both pediatric cohorts was the use of short bars. Methods: In a retrospective study, pediatric PE corrections involving ‘short bars crossed’ were analyzed for complications and intra-/postoperative outcomes. Cases with two or three bars were included, given that a horizontal third bar was placed whenever considered useful for upper-chest elevation. All bars were fitted with a single stabilizer near the surgical entry point. In the Austrian center, intercostal nerve cryoablation was used for pain management. Descriptive statistics are presented. Results: Seventy-eight patients ≤18 years old were evaluable at the Turkish (n = 56) and Austrian (n = 22) centers. Total median values were 16.2 (IQR: 15.1–17.4) years for age and 4.60 (IQR: 3.50–6.11) for Haller index. Ten mild or moderate complications (12.8%) were observed, including just one revision requirement due to bar migration (1.28%). Intercostal nerve cryoablation (n = 13) was associated with longer surgical procedures at 150 (IQR: 137–171) versus 80 (IQR: 60–100) minutes but with shorter hospital stays, given an IQR of 3–4 days versus 4–5 days. Conclusion: ‘Short bars crossed’—with a single stabilizer in a ventral position close to the surgical entry point—ensure a wide distribution of forces, protect against bar migration, are safe and effective, and offer stability at an age characterized by growth and physical activity. Level of Evidence: IV.
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Tıp, Dahili Tıp Bilimleri, Çocuk Sağlığı ve Hastalıkları, Cerrahi Tıp Bilimleri, Sağlık Bilimleri, Medicine, Internal Medicine Sciences, Child Health and Diseases, Surgery Medicine Sciences, Health Sciences, Klinik Tıp (MED), Klinik Tıp, CERRAHİ, PEDİATRİ, Clinical Medicine (MED), CLINICAL MEDICINE, SURGERY, PEDIATRICS, Cerrahi, Pediatri, Perinatoloji ve Çocuk Sağlığı, Surgery, Pediatrics, Perinatology and Child Health, Cross-bar technique, Entire chest wall repair, Minimally invasive repair of pectus excavatum, Pectus excavatum, Short-bar technique
Citation
Weinhandl A. C., ERMERAK N. O., YÜKSEL M., Rebhandl W., "‘Short Bars Crossed’ to Remodel the Entire Chest Wall in Children and Adolescents with Pectus Excavatum", Journal of Pediatric Surgery, 2024