Minimally invasive repair of pectus carinatum using the Abramson technique
Gregor Kocher1, Konstantinos Gioutsos2, Thanh-Long Nguyen2
1Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Pectus carinatum treatment has evolved from invasive surgery to less invasive methods. A new technique using a pectus bar offers a minimally invasive solution, addressing challenges in stabilizing the bar.
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Minimally invasive surgery
Background:
- Traditional pectus carinatum treatment involved invasive Ravitch procedures, leading to complications like chronic pain and restricted chest wall mobility.
- Nonsurgical and minimally invasive sternal compression methods have become prevalent for pectus carinatum, particularly in children.
- Compressive brace treatments show limitations in adolescents and older patients, necessitating alternative approaches.
Discussion:
- The Abramson procedure presents a minimally invasive technique for pectus carinatum correction using an anteriorly placed pectus bar.
- This method is less invasive than pectus excavatum repair but faces challenges in lateral fixation of the pectus bar.
- The study details the technical steps of the Abramson procedure, including a novel solution for stabilizer fixation.
Key Insights:
- The Abramson procedure offers a less invasive alternative to traditional pectus carinatum surgeries.
- Effective lateral fixation of the pectus bar is crucial for successful outcomes in this technique.
- A specific fixation method for stabilizers has been developed and demonstrated.
Outlook:
- Further evaluation of the Abramson procedure's long-term efficacy and patient outcomes is warranted.
- Refinements in fixation techniques could enhance the applicability of this minimally invasive approach.
- This technique holds potential for improved pectus carinatum management in adolescent and adult populations.
Abstract:
In the past, the treatment of pectus carinatum has been managed by open, invasive surgical procedures, which involved the resection of cartilage growth plates (Ravitch procedure). By preventing normal bony growth and maturity, this technique often led to postoperative complications, such as acquired thoracic dystrophy, chronic pain and scarring, and stiffness of the whole anterior chest. Dyspnea and exercise intolerance due to restricted thoracic space and cardiac compression were not uncommon as well. Over the last 2 decades, nonsurgical and minimally invasive approaches have gained ground because it was recognized that simple sternal compression was able to remodel the elastic anterior chest wall and therefore correct pectus carinatum adequately/efficiently, at least in children. However, failure of this compressive brace treatment is not uncommon in adolescents and older patients. Abramson therefore developed a minimally invasive technique for the correction of pectus carinatum using a pectus bar that is placed anteriorly to the sternum. The procedure is less invasive and less risky than a pectus bar inserted for pectus excavatum, but the lateral fixation of the pectus bar in the Abramson procedure remains a challenge. We demonstrate the technical aspects of the procedure step by step including our solution for fixation of the stabilizers.
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