초록접수 현황
| 15F-178 | 구연 발표 |
Minimally Invasive Repair of Pectus Excavatum for Failed Open Repair
김경수, 박형주
가톨릭대학교 의과대학 서울성모병원 흉부외과학교실
Background : It is difficult to manage patients with recurrent pectus deformities after prior open surgery due to severe adhesion, previous incision wound, deformed sternum with weakened bony thorax, insufficient remodeling of bone and patient’s psychic trauma. The purpose of this study is to present our experience and discuss the minimally invasive strategy (MIRPE) for patients with a history of prior open surgery.
Methods : Between 1999 and 2015, a data of total 2484 patients who underwent MIRPE was reviewed. Forty two patients who had previous open repair from elsewhere and subsequently underwent MIRPE in our institute were enrolled. We performed morphology-tailored approach with reopening the previous anterior scar, sternal elevation using crane system, pectoscopy or thoracoscopy guided dissection, half-bridge method, muscle transposition and cartilage resection for pectoplasty. All patients were reassessed for targeting the depression and hinge points.
Results : Of total 113 (4.5%) failed pectus surgery patients including MIRPE patients and bar removal cases, there were 42 failed open surgery cases with prior 38 Ravitch and 4 Wada procedures. The mean age was 17 years (range, 3–39 years) with male to female ratio of 8.7. The mean age at the prior open surgery was 8 years (range, 3-20 years). Grossly broad depression and Grand-canyon morphology (14/42; 42.4%) was the characteristic appearance. Complications comprised with 2 pneumothorax, 1 pneumonia, 1 pericardial effusion, 1 postoperative bleeding, 2 wound seroma and 1 wound infection. The mean hospital stay was 8 days (range, 4 to 24 days). There were neither cases of bar displacement nor life-threatening event such as cardiac perforation that mortality case was zero. Bar removal was conducted in 30 (71.4%) patients with no recurrent deformity. All patients demonstrated good morphologic shape with satisfactory results.
Conclusion : Reoperation with MIRPE for the previous insufficient open repair is hard to manage but it can be performed by developing various techniques with a favorable outcomes. We conclude that redo-MIRPE is an acceptable modality for correcting for recurrent pectus deformity after failed open surgery in selective cases.
Methods : Between 1999 and 2015, a data of total 2484 patients who underwent MIRPE was reviewed. Forty two patients who had previous open repair from elsewhere and subsequently underwent MIRPE in our institute were enrolled. We performed morphology-tailored approach with reopening the previous anterior scar, sternal elevation using crane system, pectoscopy or thoracoscopy guided dissection, half-bridge method, muscle transposition and cartilage resection for pectoplasty. All patients were reassessed for targeting the depression and hinge points.
Results : Of total 113 (4.5%) failed pectus surgery patients including MIRPE patients and bar removal cases, there were 42 failed open surgery cases with prior 38 Ravitch and 4 Wada procedures. The mean age was 17 years (range, 3–39 years) with male to female ratio of 8.7. The mean age at the prior open surgery was 8 years (range, 3-20 years). Grossly broad depression and Grand-canyon morphology (14/42; 42.4%) was the characteristic appearance. Complications comprised with 2 pneumothorax, 1 pneumonia, 1 pericardial effusion, 1 postoperative bleeding, 2 wound seroma and 1 wound infection. The mean hospital stay was 8 days (range, 4 to 24 days). There were neither cases of bar displacement nor life-threatening event such as cardiac perforation that mortality case was zero. Bar removal was conducted in 30 (71.4%) patients with no recurrent deformity. All patients demonstrated good morphologic shape with satisfactory results.
Conclusion : Reoperation with MIRPE for the previous insufficient open repair is hard to manage but it can be performed by developing various techniques with a favorable outcomes. We conclude that redo-MIRPE is an acceptable modality for correcting for recurrent pectus deformity after failed open surgery in selective cases.
책임저자: 박형주
가톨릭대학교 의과대학 서울성모병원 흉부외과학교실
연락처 : 김경수, Tel: 02-2258-6139 , E-mail : cskks@catholic.ac.kr
