title: Absorbable stabilisation of the bar in minimally invasive repair of pectus excavatum.
abstract: BACKGROUND
  The minimally invasive repair of pectus excavatum has become the preferred technique in most centres. One of the most important technical points for the final result is stabilisation of the bar, usually obtained by one or two metal stabilisers. Recently, long-term absorbable stabilisers have become available (LactoSorb, Biomet, Jacksonville, FL, USA). Made of poly-L-lactic and polyglycolic acid, they have been introduced with the aim of reducing local discomfort and making removal of the bar easier. Their efficacy for the stabilisation of the bar has not been proved yet. In this paper we compare the surgical outcome in two groups of patients, one treated with metallic and the other with absorbable stabilisers.
  
  
  METHODS
  A total of 280 patients underwent pectus excavatum repair using a Nuss technique in two centres. In 194 patients (group 1), operated on since 2001, the metallic stabiliser was used. In 86 patients (group 2), operated on since February 2007, the LactoSorb stabiliser was preferred. We compared both groups in terms of surgical details, local symptoms or complications, and bar instability rate.
  
  
  RESULTS
  The surgical technique for the stabilisation of the bar was identical in both groups, but in group 1 the stabiliser was fastened to the bar with a steel wire, while in group 2 polyglycolic sutures were used. No differences in local discomfort or postoperative pain were observed between the groups. The LactoSorb stabiliser was palpable for at least 6-9 months, and progressively disappeared at 9-12 months. In group 1 we observed 6 local complications. In particular, two patients presented with infection, one of them associated with a skin lesion and opening over the metallic stabiliser (revision of the wound was performed). Another patient developed a thoracic wall haematoma after suffering a trauma over the metallic stabiliser, 13 months after operation. Three patients developed a seroma. In group 2 we observed 3 subcutaneous swellings at the site of the LactoSorb stabiliser at 6, 8 and 9 months after the operation. We did not observe either skin lesions or infections. In the group with metallic stabiliser, 3 patients (1.5 %) had bar dislocation, while we did not observe bar instability in the group with LactoSorb stabiliser.
  
  
  CONCLUSIONS
  LactoSorb stabiliser is safe and effective for stabilising the bar in pectus surgery. We suggest its routine use as it appears to be less traumatic and could make bar removal easier.
authors.affiliation: Pediatric Surgery, G. Gaslini Institute, Genova, Italy. micheletorre@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Torre
authors.forename: V
authors.initials: V
authors.lastname: Jasonni
authors.forename: C
authors.initials: C
authors.lastname: Asquasciati
authors.forename: S
authors.initials: S
authors.lastname: Costanzo
authors.forename: M V
authors.initials: MV
authors.lastname: Romanini
authors.forename: P
authors.initials: P
authors.lastname: Varela
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D001672:Biocompatible Materials; D002648:Child; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D019344:Lactic Acid; D008670:Metals; D019060:Minimally Invasive Surgical Procedures; D011100:Polyglycolic Acid; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D012189:Retrospective Studies; D053831:Surgical Fixation Devices / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D008670:Metals; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid