A. S. Poola1, S. W. Sharp1, S. D. St. Peter1 1Children’s Mercy Hospital – University Of Missouri Kansas City,Pediatric Surgery,Kansas City, MO, USA
Introduction:
Since its description, the Nuss procedure has been implemented as an effective minimally invasive repair for children and adolescents with pectus excavatum. While there has been much published literature on pectus bar placement, there are a limited number of reports studying the corresponding bar removal procedure. Even less reported is the post-operative management following bar removal. Common practices have included obtaining a post-operative chest radiograph (CXR) despite the minimal risk of intra-thoracic complications associated with this procedure. The aim of this study is to review our experience with the bar removal procedure and with not obtaining routine CXRs following this operation.
Methods:
A single institution retrospective chart review was performed from 2000 to 2012. Patients aged 8-35 who underwent a pectus bar removal procedure were included. We assessed operative timing of bar placement and removal, length of procedure and post-operative radiograph findings, specifically looking at rate of pneumothoraces.
Results:
335 patients were identified in this study. Of these, 80 percent were male. The mean age of bar placement was 14 years with a standard deviation of 3 years while the mean age of bar removal was 16 years with a standard deviation of 3.5 years. The average time between bar placement and bar removal was 33 months (range: 11-110 months). Most of our patients had one bar placed at initial procedure while 8 percent had two bars placed during repair. Operative times varied but on average bars were removed in 30 minutes (range: 10-96 min). Intra-operatively, 8 percent of patients had ossification of their bars although there was no noticeable effect of this finding on operative time. Of our sample, 143 patients obtained a post-operative radiograph and of these 139 films revealed a pneumothorax. Only 1 patient obtained a chest tube for management of their post-operative pneumothorax. Only three patients were re-admitted and zero patients were hospitalized following their procedures.
Conclusion:
Despite the detection of early post-operative pneumothoraces following bar removal, we have seldom found the need to clinically intervene on these findings. This suggests that not obtaining routine imaging following bar removal may be a safe practice.