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MINERVA PEDIATRICA

A Journal on Pediatrics, Neonatology, Adolescent Medicine,
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Minerva Pediatrica 2008 August;60(4):391-6

language: Italian

The treatment of pectus excavatum: results of a mininvasive surgical technique on the first 50 patients

Torre M. 1, Mameli L. 2, Montobbio G. 2, Asquasciati C. 1, Campanella V. 1, Ferrari C. 3, Jasonni V. 1

1 Dipartimento di Chirurgia Pediatrica Istituto Giannina Gaslini, Genova, Italia
2 Dipartimento di Anestesia e Rianimazione, Istituto Giannina Gaslini, Genova, Italia
3 Dipartimento di Fisioterapia Istituto Giannina Gaslini, Genova, Italia


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Aim. Pectus excavatum is the commonest thoracic congenital malformation, but its treatment remains not well known. The authors present the results of the mini-invasive repair at G. Gaslini Institute of Genoa, Italy.
Methods. Nuss mini-invasive repair avoids anterior scars. The correction is achieved by the introduction under thoracoscopy of a retrosternal curve bar that is rotated by 180°. Postoperatory pain is managed by an epidural catheter. In all the operated patients we evaluated the clinical pre-operatory parameters (spirometric, radiological and cardiological data), the surgical details and the results.
Results. Fifty patients were operated, 43 of them males, ranging from 7 and 22 years of age, with an average of 17 years of age. Only 8 of them were asymptomatic and required surgery for psychological reasons. The 74% presented some stress dyspnea. Some impairment in spirometric parameters were observed in 28% and mitral valve prolapse in 30%. The only significant intra-operative complication was a bleeding from a thoracic wall vessel that required a left emergency minimal thoracotomy. Postoperative complications were: 2 pneumothorax (drained for 24 hours), 2 transitory pulmonary atelectasis, 1 hemothorax in a patient with coagulation deficit, 3 wound problems (1 infection and 2 hematomas). The esthetical score after surgery, according to the patients, was 9.15 on average, in a scale from 1 to 10. None rated less than 7. The pain score with the same scale was rated 6.8 on average.
Conclusion. The Nuss technique is safe and guarantees very satisfactory esthetical results.

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