Abstract:
BACKGROUND:We sought to examine our institutional experience (1998 to 2014) with minimally invasive repairs of pectus excavatum (MIRPE). STUDY DESIGN:We conducted a retrospective review and a mailed survey (quality of life assessment). Associations with reoperation due to bar migration and recurrence after bar removal were evaluated with logistic regression. RESULTS:Three hundred and thirteen patients (79% male) underwent MIRPE at a mean ± SD age of 15 ± 3 years. Bar migration requiring reoperation occurred in 16 (5%) patients (median 26 days, interquartile range 15 to 70 days from repair). Wire fixation (hazard ratio [HR] = 3.16; p = 0.014) and bar stabilizer (HR = 4.57; p = 0.002) use were associated with increased risk of reoperation, and bilateral pericostal suture fixation (HR = 0.15; p < 0.001) and thoracoscopic assistance (78%, HR = 0.23; p < 0.001) were associated with decreased risks. Reoperations rates varied (6% to 26%) during the first 50 cases of each surgeon (n = 6), falling to ≤2% afterward. Of the 101 (32%) patients who have had their bars removed electively, 10 (10%) have required reoperation for recurrence. Patients with a recurrence after bar removal were younger (14.1 ± 3.9 years vs 18.4 ± 3.7 years; p = 0.007) and had their bars removed earlier (2.4 ± 1.2 years vs 3.8 ± 2.1 years; p = 0.036). Of survey respondents (n = 145 [47%]), most (99%) were either very happy (n = 79) or mostly happy (n = 63) with their outcomes. CONCLUSIONS:Although excellent outcomes after MIRPE can be achieved, our results highlight identified strategies that are associated with decreased risk of reoperation (eg, use of bilateral pericostal suture fixation, surgeon experience, and thoracoscopic guidance). Our results also suggest that elective bar removal should be delayed until the patient is at least 18 years old and has had the bar in for at least 4 years.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Gibreel W,Zendejas B,Joyce D,Moir CR,Zarroug AEdoi
10.1016/j.jamcollsurg.2015.11.020subject
Has Abstractpub_date
2016-03-01 00:00:00pages
245-52issue
3eissn
1072-7515issn
1879-1190pii
S1072-7515(15)01737-8journal_volume
222pub_type
杂志文章abstract:BACKGROUND:Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN:The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS:Five hu...
journal_title:Journal of the American College of Surgeons
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abstract::During a nine year period, the authors treated 37 patients with angiographic catheter induced arterial occlusions. Twenty-nine patients presented with acutely ischemic extremities requiring urgent intervention. Arterial thrombosis followed transfemoral cardiac catheterization or angioplasty in 13 patients, transbrachi...
journal_title:Journal of the American College of Surgeons
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更新日期:2005-01-01 00:00:00
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更新日期:2017-03-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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