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An Effect of Nuss Procedure on Lung Function Among Patients with Pectus Excavatum

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Szydlik S., Jankowska-Szydlik J., Kasprzyk M., Dyszkiewicz W., Adamczak J., Zwaruń D.
Polish Journal of Surgery
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2013
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vol. 85
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issue 1
1-5
EN
The aim of the studywas to evaluate lung function among patients who underwent Nuss Procedure. The analysis included spirometric evaluation of the lung function before Nuss Procedure, during perioperative period and after removing steel bars from behind the sternum. Material and methods.The study group involved patients operated on the pectus excavatum in the Department of Thoracic Surgery in Poznań in years 2002-2004. The study group consisted of 44 patients (5 females and 39 males). Aged between 10 to 32 years old, the mean age was 16. The following spirometric parameters were analysed: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/VC ratio, peak expiratory flow (PEF), forced expiratory flow for 25% (FEF25), 50% (FEF50) and 75% FVC (FEF75). Results.The values of the FVC, FEV1, FEF25, and FEV1/VC ratio in the study group were significantly higher in the postoperative period in comparison with the preoperative period. There was a statistically significant correlation between the improvement in spirometric parameters after Nuss Procedure and the impairment of spirometric values in preoperative period. There were no statistical differences between the value of initial chest deformation and spirometric parameters improvement. There were also no statistically significant correlations between age, height and weight of the patient in the study group and spirometric values improvement. Conclusion.There is a statistical improvement in lung function in patients who underwent Nuss Procedure. The improvement in spirometric parameters correlates with the impairment of spirometric values in the preoperative period.
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Video-Assisted Thoracoscopic Surgery (VATS) Vs Thoracotomy in the Surgical Treatment of Recurrent Spontaneous Pneumothorax

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Kasprzyk M., Dyszkiewicz W., Piwkowski C., Pawlak K., Adamczak J., Zieliński P., Zwaruń D.
Polish Journal of Surgery
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2008
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vol. 80
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issue 3
118-123
EN
The aim of the study was to compare surgical treatment results in cases of recurrent spontaneous pneumothorax following video-assisted thoracoscopic surgery (VATS) and thoracotomy. We assessed the recurrence rate after the procedures and postoperative complications, considering two patient groups.Material and methods. The study group was comprised of 127 patients subjected to surgical treatment due to recurrent spontaneous pneumothorax during the period between 1996 and 2005. The group of 43 women and 84 men was between 15 and 79 years of age (mean age: 37 years). Video-assisted thoracoscopic surgery was performed in 67 cases, while the remaining 60 patients underwent thoracotomy. We performed the excision of the emphysematous blebs or apex of the lungs in 96 patients, partial pleurectomy with mechanical pleurodesis in 73 patients, subtotal pleurectomy in 33 cases, decortication of the lung in 30 cases, and chemical pleurodesis in 13 patients.Results. Pneumothorax recurrence was significantly more frequent in the group of patients following the minimally-invasive approach (28% vs 8%). We observed no statistically significant differences considering patient gender in both groups. However, the VATS approach had a tendency to be performed in younger patients (average 33 yrs. in VATS vs 42 yrs. in the thoracotomy group). We performed partial pleurectomy and mechanical pleurodesis more often during VATS, while subtotal pleurectomy and lung decortication were performed more frequently during thoracotomy. The percentage of resections, considering emphysematous blebs or lung apexes was similar in both patient groups. We observed no differences considering the duration and amount of postoperative drainage, hospitalization period, or percentage of postoperative complications (pleural hematoma, prolonged air leak, residual pneumothorax) between both groups.Conclusions. Apart from the excision of emphysematous blebs, subtotal pleurectomy should be considered in cases of patients subjected to video-assisted thoracoscopy. Subtotal pleurectomy could decrease the risk of recurrent pneumothorax, while having comparable percentages of postoperative complications as those following mechanical pleurodesis.
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