A New Perspective on Correction

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Presentation transcript:

A New Perspective on Correction Pectus Excavatum A New Perspective on Correction

What is Pectus Chest wall abnormality1 Sternum and ribs depressed inwards Number one birth defect in males2 1 of 8 92% of patients unaware it could be affecting their health2 Fronkalsrud, EW M.D. Nuss D, Kelly M.D.

Symptoms Physical Psychological Chest pain, cardiac/respiratory complications, lack of stamina3 Psychological Self conscious behavior, loss of motivation, anxiety1 Often misdiagnosed by the doctor or ignored by the patient2 Three procedures Nuss Ravitch Silicone implants 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 surgery1 What is a successful pectus surgery? Dr. Cohn: leading pectus excavatum surgeon2 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 possible1 Less blood loss 68% something unexpected happens under anesthesia Fonkalsrud, EW M.D. Nuss, D Kelly M.D.

Procedure Ravitch Procedure Nuss Procedure Nuss Procedure

Evidence Study on 8 patients4 Data Collected 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 post-hospitalization 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 Fonkalsrud, EW M.D. Repair of pectus excavatum and caratum in adults. American Journal of Surgery. 1961; 101: 588-597. 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. Shamberger, RC M.D. Cardiopulmonary function is pectus excavatum. Surgery 1988; 166: 383-391. Cohn, Dale M.D. What is new in pectus excavatum surgery. Journal of Surgery. 2001; 38: 784-789.