Comparison of conservative and surgical treatment of pectus carinatum in children

Authors

  • V. R. Zaremba Communal Institution «Zhytomyr Regional Children’s Clinical Hospital» of Zhytomyr Regional Council, Ukraine, Ukraine
  • O. A. Danylov Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine, Ukraine
  • I. D. Shulga Communal Institution «Kryvyi Rih City Clinical Hospital No.8» of Dnipro Regional Council, Ukraine, Ukraine
  • M. O. Dotsenko Communal Institution «Zhytomyr Regional Children’s Clinical Hospital» of Zhytomyr Regional Council, Ukraine, Ukraine
  • O. S. Kurochkin Communal Institution «Kryvyi Rih City Clinical Hospital No.8» of Dnipro Regional Council, Ukraine, Ukraine

DOI:

https://doi.org/10.15574/PS.2018.60.18

Keywords:

pectus carinatum, conservative treatment, minimally invasive surgical treatment, dynamic compression brace

Abstract

An analysis of conservative treatment of 58 patients with pectus carinatum using a brace system of original design during the period of November 2015–June 2018 was conducted. In addition, the analysis of surgical treatment of 111 patients with pectus carinatum operated according to Abramson in the modification of D.I. Shulga was carried out. The patients were operated during the period of 2009-2018. In all cases of non-operative completed treatment, a recovery was achieved; all patients with incomplete conservative treatment had positive changes and treatment is continued. In one case a tendency to relapse was revealed, which required the а prolongation of treatment for 4 months. Certain advantages of the in-house design of the dynamic compression brace are noted. A similar brace was constructed for correcting the concomitant protrusion of costal arches; another brace was used for the first time for pectus carinatum correction in teenage girls and women. The first experience of the comprehensive simultaneous non-operative treatment of pectus carinatum, combined with severe kyphosis, scoliosis and kyphoscoliosis, was illuminated. The features, advantages of the anterior minimally invasive thoracoplasty according to Abramson-Shulga were noted. Good functional and cosmetic surgical results in all cases were achieved. The fixing arc – a plate of own design was proposed. The functional status of the cardiorespiratory system was analysed before and after the treatment. The comparative analysis of the conservative and surgical treatment results was made.

References

Pohorilyi VV, Kukuruza YuP, Loiko YeIe ta in. (2011). Likuvannia vrodzhenoi kilepodibnoi deformatsii hrudnoi klitky ta pochatkovykh stadii skoliozu u ditei. Aktualni problemy diahnostyky, likuvannia ta reabilitatsii ditei z travmamy ta zakhvoriuvanniamy oporno-rukhovoho aparatu: materialy nauk.-prakt. konf. z mizhnar. uch., 14–15 kvitnia 2011 r. Kyiv: 161.

Pohorilyi VV, Sasiuk AI, Loiko YeIe ta in. (2015). Rezultaty zastosuvannia maloinvazyvnoi khirurhii pry likuvanni vrodzhenoi kilopodibnoi deformatsii hrudnoi klitky u ditei. Torakalna khirurhiia Ukrainy sohodni: vyklyky ta shliakhy yikh podolannia: materialy Sympoziumu z mizhnarodnoiu uchastiu, prysviachenoho 40 richchiu zasnuvannia kafedry torakalnoi khirurhii i pulmonolohii NMAPO im. PL Shupyka, 1–2 zhovt. Kyiv:50–51.

Razumovskiy AYu, Alhasov AB, Rachkov VE i dr. (2011). Torakoplastika pri kilevidnoy deformatsii grudnoy kletki u detey. Hirurgiya. 4: 25–31.

Razumovskiy AYu, Savchuk MO, Pavlov AA. (2012). Kilevidnaya deformatsiya grudnoy kletki. Detskaya hirurgiya. 1: 45–49.

Shulga DI, Loyko EE, Sasyuk AI, Dobrovanov AE. (2010). Maloinvazivnyiy sposob peredney plastiki – novyiy metod lecheniya vrozhdennoy kilevidnoy deformatsii grudnoy kletki u detey. Novyie tehnologii v pediatrii i detskoy hirurgii: materialyi Respublikanskoy nauch.-prakt. konf., Alushta, 28–29 oktyabrya.

Abramson H, D’Agostino J, Wuscovi S. (2009). A 5-year experience with a minimally invasive technique for pectus carinatum repair. J Pediatr Surg. 44:118–124. https://doi.org/10.1016/j.jpedsurg.2008.10.020; PMid:19159728

Ala Stanford Frey, Victor F Garcia, Rebeccah L Brown, Thomas H Inge, Frederick C Ryckman, Aliza P Cohen, Greg Durrett, Richard G Azizkhan. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery. 41:40–45. https://doi.org/10.1016/j.jpedsurg.2005.10.076; PMid:16410105

Cohee AS, Lin JR, Frantz FW et al. (2013). Staged management of pectus carinatum. J Pediatr Surg. 48:315-20. https://doi.org/10.1016/j.jpedsurg.2012.11.008; PMid:23414858

Fonkalsrud EW, Beans S. (2011). Surgical Managment of Pectus Carinatum: 30 Eears Experience. J World Surg. 25: 898–903. https://doi.org/10.1007/s00268-001-0048-x

Fonkalsrud EW. (2008). Surgical correction of pectus carinatum: lessons learned from 260 patients. J Pediatr Surg. 43: 1235–1243. https://doi.org/10.1016/j.jpedsurg.2008.02.007; PMid:18639675

Frey AS, Garcia VF, Brown RL, Inge TH, Ryckman FC, Cohen AP et al. (2006). Nonoperative management of pectus carinatum. Jour Pediatr Surg. 41:40–45. https://doi.org/10.1016/j.jpedsurg.2005.10.076; PMid:16410105

Haje SA, Bowen JR. (1992, Nov-Dec). Preliminary results of orthotic treatment of pectus deformities in children and adolescents. J Pediatr Orthop.12 (6): 795–800. https://doi.org/10.1097/01241398-199211000-00018; PMid:1452753

Jaubert de Beaujeu M. (1964). Thorax en carene. Lyon Chir. 60: 440–3.

Kim S, Idowu OJ (2009, Feb). Minimally invasive thoracoscopic repair of unilateral pectus carinatum. Pediatr Surg.44(2).

Kravarusic D, Dicken BJ, Dewar R, et al. (2006). The Calgary protocol for bracing of pectus carinatum: a preliminary report. J Pediatr Surg. 41:923–6. https://doi.org/10.1016/j.jpedsurg.2006.01.058; PMid:16677884

Manuel Lopez, Arnaud Patoira, Francois Varleta, Eduardo Perez Etcheparea, Theophile Tiffeta, Aurelien Villarda and Olivier Tiffet. (2013). Preliminary study of efficacy of dynamic compression system in the correction of typical pectus carinatum. European Journal of Cardio-Thoracic Surgery. 44: 316–319. https://doi.org/10.1093/ejcts/ezt425; PMid:24014551

Marcelo Martinez-Ferro, Gaston Bellia Munzon, Carlos Fraire, Constanza Abdenur, Emilio Chinni, Bruno Strappa, Laura Ardigo. (2016, March). Non-surgical treatment of pectus carinatum with the FMF® Dynamic Compressor System. Journal of Visualized Surgery. https://doi.org/10.21037/jovs.2016.02.20; PMid:29078485 PMCid:PMC5638266

Martinez-Ferro M, Fraire C, Bernard S. (2008). Dynamic compression system for the correction of pectus carinatum. Semin Pediatr Surg. 17:194–200. https://doi.org/10.1053/j.sempedsurg.2008.03.008; PMid:18582825

Martinez-Ferro M. (2012). International innovations in pediatric minimally invasive surgery: the Argentine experience. J Pediatr Surg. 47:825–35. https://doi.org/10.1016/j.jpedsurg.2012.01.030; PMid:22595556

Oguz Ates.Osman Z Karakus, Gulce Hakguder, Mustafa Olguner and Feza M Akgur. (2013, Sept., 1). Pectus carinatum: the effects of orthotic bracing on pulmonary function and gradual

compression on patient compliance. European Journal of Cardio-Thoracic Surgery. 44; 3:228–232.

Ravitch MM. (1986). The chest wall. In: Welch KJ, Randolph JG, Ravitch MM O’Neill JA, and Rowe MI. (Eds). Pediatric Surgery 4 th Edition. New York (NY): 578–561.

Robicsek F, Fokin AA. (2004). How not to do it: restrictive thoracic dystrophy after pectus excavatum repair. Interact Cardio-Vasc and Thorac Surg. 3:566–568. https://doi.org/10.1016/j.icvts.2004.06.007; PMid:17670312

Saxena AK. (2009). Pectus excavatum, pectus carinatum and other forms of thoracic deformities. J Indian Assoc Pediatr Surg.10: 147–157. https://doi.org/10.4103/0971-9261.16964

Schaarschmidt K, Kolberg-Schwerdt A, Lempe M and Schlesinger F. (2006). New endoscopic minimal access pectus carinatum repair using subpectoral carbon dioxide. Ann Thorac Surg. 81: 1099–1104. https://doi.org/10.1016/j.athoracsur.2005.10.042; PMid:16488731

Seock Yeol Lee, Seung Jin Lee, Cheol Woo Jeon, Cheol Sae Lee, Kihl Rho Lee. (2008). Effect of the compressive brace in pectus carinatum. European Journal of Cardio-Thoracic Surgery. 34: 146–149. https://doi.org/10.1016/j.ejcts.2008.04.012; PMid:18479931

Shamberger RC, Welch KJ, Castaneda AR, Keane JF, Fyler DC. (1988). Anterior chest wall deformities and congenital heart disease. Jour Thorac Cardiovasc Surg. 96:427–432. PMid:3411988

Steinmann C, Krille S, Mueller A et al. (2011). Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg. 40:1138–45. https://doi.org/10.1016/j.ejcts.2011.02.019

Downloads

Issue

No. 3(60) (2018): Paediatric Surgery. Ukraine

Section

Original articles. Thoracic surgery

License

The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).

Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.

Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.

The use of published materials for commercial purposes is strongly prohibited.