Can absorbable stabilizers be used routinely in the Nuss procedure?
OBJECTIVE
During minimal invasive surgical correction of pectus excavatum the metal bar is rotated 180 degrees and fixed by one or two stabilisers. Previously, all stabilisers were made from metal, but they often caused chronic pain and had to be removed. Recently, a slowly absorbable stabiliser made from Lactosorb has been introduced.


METHODS
From 2001 to 2008 a total of 507 patients underwent minimally invasive repair of pectus excavatum at Aarhus University Hospital. Since February 2007 we routinely used absorbable stabilisers made by Lactosorb. We always used shorter pectus bars than originally suggested and always placed one stabiliser close to the entry in the thoracic cavity on the left side. All operations were performed by the same surgeon and all patients were seen 6 weeks after surgery. Patient records were reviewed for retrospective analysis.


RESULTS
In 422 patients we used a metal stabiliser while 85 patients received a Lactosorb stabilizer. Seven patients received two stabilisers. During the follow-up period one metal stabiliser broke after 2(1/2) years (0.2%), but within 6 weeks after surgery three Lactosorb stabilizers broke (3.5%) and another three dislocated laterally (3.5%).


CONCLUSIONS
Absorbable stabilisers may be used for minimal invasive surgery for pectus excavatum but they are more vulnerable and break easier than metal stabilisers. This is likely a consequence of high stress forces that may be more pronounced in patients who receive a shorter pectus bar, but further research is needed.
Pilegaard
Hans K
HK
Department of Cardiothoracic Surgery, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
Licht
Peter B
PB
D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D009984:Orthopedic Fixation Devices; D011100:Polyglycolic Acid; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid