Pectus Excavatum A New Perspective on Correction What

Pectus Excavatum A New Perspective on Correction

What is Pectus • Chest wall abnormality 1 – Sternum and ribs depressed inwards • Number one birth defect in males 2 – 1 of 8 • 92% of patients unaware it could be affecting their health 2 1. Fronkalsrud, EW M. D. 2. Nuss D, Kelly M. D.

Symptoms • Physical – Chest pain, cardiac/respiratory complications, lack of stamina 3 • Psychological – Self conscious behavior, loss of motivation, anxiety 1 • • Often misdiagnosed by the doctor or ignored by the patient 2 Three procedures – Nuss – Ravitch – Silicone implants 1. 3. Shamberger, RC M. D. 2. Nuss D, Kelly M. D.

Claim • Nuss procedure is a more successful procedure for surgical correction of pectus excavatum than the Ravitch procedure.

Warrants • Minimally invasive surgery – Faster recovery than invasive surgery 1 • What is a successful pectus surgery? – Dr. Cohn: leading pectus excavatum surgeon 2 • Six Criteria: – Relief of cardiac/pulmonary compressions – Adequate pain management – Length of hospital stay – Time to return to normal activity – Duration of daily medication – Physical appearance • Operating time you want as short as possible 1 – Less blood loss – 68% something unexpected happens under anesthesia 1. Fonkalsrud, EW M. D. 2. Nuss, D Kelly M. D.

Procedure Ravitch Procedure Nuss Procedure

Evidence • Study on 8 patients 4 – Minimally invasive Nuss 4 patients – Ravitch 4 patients • Five Men & Three Women • Data Collected – Operating time, duration of epidural, pain scores, hospital stay, alleviation of symptoms, time to return to normal activity, complications, duration of posthospitalization pain medication, and physical appearance. 4. Cohn, Dale M. D.

Evidence • Ravitch Complications – 2 suffered from cardiac compressions – 1 collapsed lung – admitted to ICU – 3 inhibited chest wall growth – 2 urinary retention – 4 dissatisfied with scar

Before & After Ravitch Procedure Nuss Procedure

Conclusion • Nuss procedure offers many benefits – Reduced operating time, effectively stabilizes chest, vastly reduces scaring, maintains chest elasticity, does not inhibit chest growth, drastically reduces blood loss, creates more space for vital organs

References 1. Fonkalsrud, EW M. D. Repair of pectus excavatum and caratum in adults. American Journal of Surgery. 1961; 101: 588 -597. 2. Nuss, D Kelly M. D. A 10 year review of a minimally invasive technique to the correction of pectus excavatum. Journal of Pediatric Surgery. 1998; 33: 545 -552. 3. Shamberger, RC M. D. Cardiopulmonary function is pectus excavatum. Surgery 1988; 166: 383 -391. 4. Cohn, Dale M. D. What is new in pectus excavatum surgery. Journal of Surgery. 2001; 38: 784 -789.