Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome

Area of Science:

• Thoracic surgery
• Pain management
• Surgical innovation

Background:

• Minimally invasive repair of pectus excavatum (MIRPE) and cartilaginous rib excision (CRE) for slipping rib syndrome (SRS) are associated with significant postoperative pain.
• Intercostal nerve cryoablation (Cryo) has demonstrated efficacy in reducing pain and opioid consumption during MIRPE.

Purpose of the Study:

• To evaluate the effectiveness and safety of intercostal nerve cryoablation in patients undergoing CRE for SRS.
• To compare outcomes between CRE with and without cryoablation.

Main Methods:

• Retrospective chart review of 98 patients undergoing CRE between 2018 and 2022.
• Data collected included demographics, operative details, and hospital course.
• Cryoablation was applied to intercostal nerves (T9/T10) in some patients, with variations in technique (extra-thoracic vs. intra-thoracic).

Main Results:

• Patients undergoing CRE + Cryo showed significantly lower in-hospital opioid use (0.6 OME/kg) compared to CRE alone (1.0 OME/kg).
• Median length of stay was shorter for CRE + Cryo (1 day) versus CRE alone (2 days), though not statistically significant (p=0.09).
• Cryoablation, including extra-thoracic application to T10, did not result in documented abdominal wall laxity at follow-up.

Conclusions:

• Intercostal nerve cryoablation is an effective adjunct for reducing opioid requirements and potentially length of stay in patients undergoing CRE for SRS.
• Extra-thoracic cryoablation to the T9/T10 intercostal nerves is a safe technique for SRS management.
• Further prospective studies are warranted to confirm long-term outcomes.