Comparative characteristics of the efficiency of different methods of operational treatment for pectus excavatum in children: a multicenter study

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Abstract

Background. Congenital malformations of the chest are observed in 1%–4% of the population, and the most common among these is pectus excavatum (90%).

Aim. We aimed to conduct a retrospective multicenter study to compare the effectiveness of various methods of operative removal of pectus excavatum in children.

Material and methods. We retrospectively analyzed the results of the surgical treatment of funnel-like deformity of the thorax in children conducted in clinics of pediatric surgery in seven regions of Russia (1,226 patients). The ratio of boys to girls in the study population was 2.2:1. The study population was divided as per their age into the following groups: 4–7 years (n = 180, 14.7%), 8–14 years (n = 731, 59.6%), and > 14 years (n = 315, 25.7%). The average age at which most children were operated was 11.83 ± 1.24 years. All children underwent a standard preoperative laboratory examination, including a general blood test, urine tests, a biochemical blood test, a hemostasiogram; radiographic diagnostic methods were used with the calculation of the Gizycka index; functional methods of investigation, such as electrocardiography, spirography, and radioisotope scintigraphy of the lungs were also used. Children with second- or third-degree pectus excavatum underwent surgical treatment almost exclusively. The symmetrical forms of the pectus excavatum were more prevalent. In most cases, the main pathological course was complicated.

Results and discussion. The operated patients were divided into the following 3 groups: the first (n = 62): operations with the resection of the curved cartilages and external fixation of the sternum-rib complex (Bairov’s operation), the second (n = 374): thoracoplasty with the resection of warped cartilages using internal metal fixators by Timoshchenko, Ravitch, Paltia, Kondrashin), and the third (n = 790): minimally invasive operations without resection with internal fixation (Nuss operations: original and modified). In the first group, favorable results of surgical treatment were noted in 80.6% of the patients, satisfactory results were observed in 6.5%, unsatisfactory results were seen in 12.9%, and the overall effectiveness of operative correction was 87.1%. In the second group, good results of surgical treatment were recorded in 88% of the patients, satisfactory in 6.4%, and unsatisfactory in 5.6%; the overall efficiency of operative correction was 94.4%. In the third group, good results of surgical treatment were recorded in 95.3%, satisfactory in 3.8%, and unsatisfactory in 0.9%; the efficiency of operative correction was 99.1%.

Conclusion. Today, the authors consider acceptable the operations by Timoshchenko and Paltia for complex of indicators, the optimal operation is Nuss.

About the authors

Aleksandr Yu. Razumovsky

Russian Medical Research University named after N.I. Pirogov; Children’s City Clinical Hospital No 13 named after N.F. Filatov

Email: 911157@mail.ru

MD, PhD, Professor, Correspondig Member of RAS, Head of the Department of Pediatric Surgery of Russian Medical Research University named after N.I. Pirogov, Chief of the Department of Thoracic Surgery Children’s of City Clinical Hospital No 13 named after N.F. Filatov

Russian Federation, 1, Ostrovityanova street, Moscow, 117997; 15, Sadovaya-Kudrinskaya street, Moscow, 123001

Abdumanap B. Alkhasov

Children’s City Clinical Hospital No 13 named after N.F. Filatov

Email: 911157@mail.ru

MD, PhD, Professor, Thoracic Surgeon of the Department of Thoracic Surgery Children’s City Clinical Hospital No 13 named after N.F. Filatov

Russian Federation, 15, Sadovaya-Kudrinskaya street, Moscow, 123001

Maksim P. Razin

Kirov State Medical University

Author for correspondence.
Email: mprazin@yandex.ru

MD, PhD, Professor, Head of the Department of Pediatric Surgery of Kirov State Medical University

Russian Federation, 112, K. Marksa street, Kirov, 610027

Mikhail A. Axel’rov

Tyumen State Medical University; Tyumen Regional Pediatric Clinical Hospital No 2

Email: akselrov@mail.ru

MD, PhD, Head of the Department of Pediatric Surgery of Tyumen State Medical University, Chief of the Department of Pediatric Surgery No 1 Tyumen Regional Pediatric Clinical Hospital No 2

Russian Federation, 54, Odesskaya street, Tyumen, 625023; Tyumen

Natal’ya A. Tsap

Ural State Medical University

Email: tsapna-ekat@rambler.ru

MD, PhD, Professor, Head of the Department of Pediatric Surgery of Ural State Medical University

Russian Federation, 3, Repina street, Ekaterinburg, 620028

Igor’ V. Kirgizov

Central Clinical Hospital with a Polyclinic

Email: kirgizov@yandex.ru

MD, PhD, Professor, Chief of the Department of Pediatric Surgery of Central Clinical Hospital with a Polyclinic

Russian Federation, 15, Marshala Timoshenko street, Moscow, 121356

Ivan A. Abushkin

South-Ural State Medical University

Email: ivanabushkin@mail.ru

MD, PhD, Professor, Head of the Department of Pediatric Surgery of South-Ural State Medical University

Russian Federation, 64, Vorovsky street, Chelyabinsk, 454092

Grigoriy V. Slizovsky

Siberian State Medical University

Email: gvs5858@mail.ru

MD, PhD, Head of the Department of Pediatric Surgery of Siberian State Medical University

Russian Federation, 2, Moscowski Trakt, Tomsk, 634050

Evgeniy G. Skryabin

Tyumen State Medical University

Email: akselrov@mail.ru

MD, PhD, Professor, Professor of the Department of Traumatology, Orthopedics, Military Surgery of Tyumen State Medical University

Russian Federation, 54, Odesskaya street, Tyumen, 625023

Valentin A. Skobelev

Kirov Regional Pediatric Clinical Hospital

Email: mprazin@yandex.ru

MD, PhD, Chief of the Department of Pediatric Surgery of Kirov Regional Pediatric Clinical Hospital

Russian Federation, Kirov 

Mikhail A. Yagovkin

Kirov Regional Center for Traumatology, Orthopedics and Neurosurgery

Email: mprazin@yandex.ru

MD, Head of the Kirov Regional Center for Traumatology, Orthopedics and Neurosurgery

Russian Federation, Kirov

Elena G. Nekrasova

Tyumen Regional Pediatric Clinical Hospital No. 2", Tyumen, Russia

Email: tsapna-ekat@rambler.ru

Ekaterinburg

Russian Federation, Ekaterinburg Regional Pediatric Clinical Hospital No 1

Mustakhim N. Satyvaldayev

Tyumen Regional Pediatric Clinical Hospital No 1

Email: akselrov@mail.ru

MD, Chief of the Department of Thoracic Surgery Children’s of Tyumen Regional Pediatric Clinical Hospital No 1

Russian Federation, Tyumen

Aleksey V. Molchanov

Kirov Regional Center for Traumatology, Orthopedics and Neurosurgery

Email: mprazin@yandex.ru

MD, Chief of the Department of Pediatric of Kirov Regional Center for Traumatology, Orthopedics and Neurosurgery

Russian Federation, Kirov 

Svetlana I. Aprosimova

Central Clinical Hospital with a Polyclinic

Email: kirgizov@mail.ru

MD, Children’s Surgeon of the Department of Pediatric Surgery of Central Clinical Hospital with a Polyclinic

Russian Federation, 15, Marshala Timoshenko street, Moscow, 121356

Vadim A. Dudarev

Krasnoyarsk State Medical University named after V.F. Voyno-Yasenetsky

Email: kras@krasmed.ru

MD, PhD, Professor of the Krasnoyarsk State Medical University named after V.F. Voyno-Yasenetsky

Russian Federation, 1, P. Zeleznyaka street, Krasnoyarsk, 660022

Vladimir A. Malchevsky

Tyumen State Medical University

Email: akselrov@yandex.ru

MD, PhD, Professor of the Department of Pediatric Surgery of Tyumen State Medical University

Russian Federation, 54, Odesskaya street, Tyumen, 625023

Igor’ A. Broder

Tyumen Regional Pediatric Clinical Hospital No 1

Email: akselrov@mail.ru

MD, PhD, Vice-Head of the Tyumen Regional Pediatric Clinical Hospital No 1

Russian Federation, Tyumen

Natal’ya V. Olenina

Ekaterinburg Regional Pediatric Clinical Hospital No 1

Email: tsapna-ekat@rambler.ru

MD, Children’s Surgeon of the Department of Thoracic Surgery Children’s of Ekaterinburg Regional Pediatric Clinical Hospital No 1

Russian Federation, Ekaterinburg

Natal’ya S. Aleksandrova

Ekaterinburg Regional Pediatric Clinical Hospital No 1

Email: tsapna-ekat@rambler.ru

MD, Children’s Surgeon of the Department of Thoracic Surgery Children’s of Ekaterinburg Regional Pediatric Clinical Hospital No 1

Russian Federation, Ekaterinburg 

Ivan I. Kuzhelievsky

Siberian State Medical University

Email: 9111158@mail.ru

MD, PhD, Associative Professor of Department of Pediatric Surgery of Siberian State Medical University

Russian Federation, 2, Moscowski Trakt, Tomsk, 634050

References

  1. Детская хирургия. Национальное руководство / Под ред. Ю.Ф. Исакова, А.Ф. Дронова. – М.: ГЭОТАР-Медиа, 2009. [Isakov YF, Dronov AF, editors. Pediatric surgery. National guidelines. Mosсow: GEOTAR-Media; 2009. (In Russ.)]
  2. Ортопедия / Под ред. С.П. Миронова, Г.П. Котельникова. – М.: ГЭОТАР-Медиа, 2008. [Mironov SP, Kotel’nikov GP, editors. Orthopedics. Moscow: GEOTAR-Media; 2008. (In Russ.)]
  3. Creswick HA, Stacey MW, Kelly RE, Jr., et al. Family study of the inheritance of pectus excavatum. J Pediatr Surg. 2006;41(10):1699-1703. doi: 10.1016/j.jpedsurg.2006.05.071.
  4. Mansour KA, Thourani VH, Odessey EA, et al. Thirty-year experience with repair of pectus deformities in adults. Ann Thorac Surg. 2003;76(2):391-395. doi: 10.1016/s0003-4975(03)00441-7.
  5. Разумовский А.Ю., Павлов А.А., Алхасов А.Б., и др. Хирургическая коррекция воронкообразной деформации грудной клетки методом Насса // Детская хирургия. – 2006. – № 2. – С. 4–9. [Razumovsky AY, Pavlov AA, Alkhasov AB, et al. Surgical correction of funnel chest by Nuss technique. Pediatric surgery. 2006;(2):4-9. (In Russ.)]
  6. Жила Н.Г. Хирургическое моделирование правильной формы грудной клетки у детей и подростков при врожденных и приобретенных деформациях. – Хабаровск, 2002. [Zhila NG. Surgical modeling of the correct shape of the chest in children and adolescents with congenital and acquired deformities. Khabarovsk; 2002. (In Russ.)]
  7. Свидетельство о государственной регистрации программы для ЭВМ № 2015614404/ 20.05.15. Бюл. № 8. Аксельров М.А., Комаров А.П., Бродер И.А., Прокопьев Н.Я. Доступно по: http://www1.fips.ru/Archive/EVM/2015/2015.05.20/DOC/RUNW/000/002/015/614/404/DOCUMENT.PDF. Ссылка активна на 31.01.2018 [Certificate of state registration of the computer program RU No 2015614404/ 20.05.15. Byul. No 8. Aksel’rov MA, Komarov AP, Broder IA, Prokop’ev NY. Available at: http://www1.fips.ru/Archive/EVM/2015/2015.05.20/DOC/RUNW/000/002/015/614/404/DOCUMENT.PDF. Accessed Jan 31, 2018. (In Russ.)].

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Copyright (c) 2018 Razumovsky A.Y., Alkhasov A.B., Razin M.P., Axel’rov M.A., Tsap N.A., Kirgizov I.V., Abushkin I.A., Slizovsky G.V., Skryabin E.G., Skobelev V.A., Yagovkin M.A., Nekrasova E.G., Satyvaldayev M.N., Molchanov A.V., Aprosimova S.I., Dudarev V.A., Malchevsky V.A., Broder I.A., Olenina N.V., Aleksandrova N.S., Kuzhelievsky I.I.

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