The Nuss Procedure for Patients With Previous Thoracic Surgery

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  • 開胸手術の既往例に対するNuss手術の安全性と問題点
  • カイキョウ シュジュツ ノ キオウレイ ニ タイスル Nuss シュジュツ ノ アンゼンセイ ト モンダイテン

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Purpose: The Nuss procedure has become a standard operation for the repair of pectus excavatum. However, safe management of this operation for patients with previous thoracic surgery has not been reported yet. The aim of this study is to evaluate our experience of the Nuss procedure for patients with previous thoracic surgery and elucidate the risk and safe technique. Materials and Methods: Between November 2004 and December 2007, we performed the Nuss procedure in 253 patients with pectus excavatum including 27 patients who had a history of previous thoracic surgery. Of these 27 patients, 17 patients underwent operations for pectus excavatum, 6 had congenital cardiac disease, and 4 had congenital lung disease. We retrospectively evaluated the degree of pleural adhesion, method of adhesiolysis, and operative and postoperative bleeding. Results: Ten of 27 patients required adhesiolysis during the operation, while 17 underwent the operation without adhesiolysis. In 10 patients with adhesiolysis, 5 had previous Nuss procedures, 4 Ravitch procedures, and one ventricular septal defect surgery. Previous operations for pectus excavatum were more likely to require adhesiolysis than operations for congenital cardiac disease or congenital cystic lung disease. To evaluate the procedure of adhesiolysis, dissection with Ligasure in 6 patients showed less bleeding than that of blunt dissection with electrocautery in 4 patients. However, postoperative pneumothorax occurred in one patient with Ligasure dissection. Mediastinal adhesiolysis was safely performed in all cases with careful dissection using a sternal lifting hook. Conclusion: The Nuss procedure could be performed for patients with previous thoracic surgery. Previous cardiac and lung operations carried lower risk than previous pectus excavatum operations. Bleeding and pneumothorax were the most common major complications. To control intraoperative bleeding for lung adhesiolysis, Ligasure was more effective than blunt dissection with electrocautery.

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