title: The Minimally Invasive Repair of Pectus Excavatum Using a Subxiphoid Incision.
abstract: PurposeSeveral surgeons have documented outcomes following the Nuss operation. Most reports have described the use of thoracoscopy to avoid cardiac injury. Since 1999, our group has utilized a subxiphoid incision, allowing insertion of the surgeon's finger into the substernal space to help guide the bar across the mediastinum. Our initial experience has been reported and we are now reporting our entire experience to date.MethodsA retrospective review was conducted on all patients who underwent pectus excavatum repair using a subxiphoid incision from December, 1999 to September, 2015.ResultsDuring the study period, 554 repairs were performed. A total of 80% of the patients were male. The mean age was 14.3 years ± 3.1, the mean operating time was 52 minutes ± 17.4, the mean length of stay was 4.2 days ± 1.1, and the mean time to bar removal was 2.7 years ± 0.7. A total of 20 patients (3.6%) received two bars. No patients sustained cardiac injury or evidence of pericarditis. Postoperatively, 22 patients (4%) developed an infection, either cellulitis or a local abscess requiring incision and drainage and/or antibiotics. In four of these 22 patients, the wound infection developed after the bar had been removed. Only one patient required bar removal before 2 years due to an infection. A total of 12 patients required either repositioning of the bar due to rotation (4) or removal of a stabilizer due to chronic discomfort (8), 2 required early bar removal for chronic pain, and 1 patient developed a tension pneumothorax in the operating room. A recurrence has developed in two patients but neither patient has desired correction.ConclusionIn this relatively large series of patients, the addition of a subxiphoid incision to the technique has allowed for safe passage of the bar across the mediastinum to avoid cardiac injury during the Nuss operation.
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: Joanna L
authors: JL
authors: Gould
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: Ronald J
authors: RJ
authors: Sharp
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: Shawn David St
authors: SD
authors: Peter
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: Charles L
authors: CL
authors: Snyder
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: David
authors: D
authors: Juang
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: Pablo
authors: P
authors: Aguayo
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: Jason D
authors: JD
authors: Fraser
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
authors: George W
authors: GW
authors: Holcomb
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014989:Xiphoid Bone