Hyung Joo Park

Ji Won Kwak, M.D., Gongmin Rim, M.D., Ph.D., Young Mog Shim, M.D., Ph.D., Seung Keun Yoon, M.D., Ph.D., Hyung Joo Park, M.D., Ph.D.. J Chest Surg -0001;0:. https://doi.org/10.5090/jcs.26.019

Background: The outcomes and potential for recurrence following surgical correction of pectus excavatum (PE) in the pediatric population remain unresolved. We carried out non-delayed PE repair in all patients aged 5 years or older. This study aimed to verify the safety and effectiveness of pediatric PE repair, based on our 10-year research data, focusing on the incidence of recurrence and the advanced strategy of using the crane sternal pre-lifting and multiple pectus bars for anatomical chest wall remodeling. Methods: From January 2013 to July 2023, a cohort of 816 pediatric patients aged ≤10 years (range, 3–10 years) underwent PE repair using pectus bars to assess the outcomes of the procedure. Among these, we specifically focused on 173 patients who underwent surgery within the last 3 years (2020–2022), during which our approach shifted to the multiple bar technique for pediatric patients. This subset was divided into the single-bar (Group S, 87 patients) and multiple-bar (Group M, 86 patients) approaches for comparison. The analysis of outcomes included changes in the computed tomography severity index (Haller index), complication rates, length of hospital stay, and reoperation incidence, with a specific focus on recurrence. Results: The two groups had similar baseline characteristics, and there was no recurrence in either group in the recent 3-year analysis. In the single- and multiple-bar group comparisons, most Group M patients underwent repair with two pectus bars (2 bars: 84, 3 bars: 2, P=0.045). The length of stay showed no significant difference between the groups (Group S; 4.63 days vs. Group M: 4.40 days, P=0.22). Among complications, there were no life-threatening complications. Similar rates of occurrence of pleural effusion (Group S, 2.3% vs. Group M, 2.3%, P=0.96), pneumothorax (Group S, 2.3% vs. Group M, 3.4%, P=0.75), and wound complications (Group S, 1.2% vs. Group M, 0%, P=0.32) were observed in both groups. However, Group M showed less total intravenous rescue analgesic consumption (Group S, 16.5 mg vs. Group M, 13.92 mg, PConclusions: Our findings showed no significant increase in the risk of recurrence or major complications with the approach of non-delayed PE repair for all patients aged 5 years and older. Our transition from a single-bar to a multiple-bar repair approach has been crucial for achieving a thorough anatomical remodeling of the entire chest wall. This strategic shift has proven to be a safe and effective surgical method, applicable even to pediatric PE patients.

Background/Objectives: The primary objective of PE repair is to relieve compression exerted on the cardiac and pulmonary structures and enhance the thoracic cavity volume. However, the number of volumetric studies of the thoracic cavity, including the heart and lung volumes, is scarce. This study seeks to systematically evaluate the volumetric changes in these structures to assess the physiological impact obtained by PE repair. Methods: A retrospective analysis was conducted on 63 patients who underwent PE repair using the XI bar technique from April 2023 to February 2024. Volumetric changes were measured preoperatively and postoperatively using SYNAPSE 3D imaging software (Version 4.6, Fujifilm, Tokyo, Japan). Cardiac and pulmonary volumes were quantified, and CT indexes (Haller index, Depression index) were assessed. Complication rates, reoperation rates, and length of hospital stay were also analyzed. Results: The mean cardiac volume increased significantly from 458.25 mL preoperatively to 499.13 mL postoperatively (p = 0.018), showing an 8.9% increase. Pulmonary volumes, however, showed no statistically significant change, remaining stable at approximately 4371.31 mL preoperatively and 4266.87 mL postoperatively (p = 0.57). Conclusions: Repairing PE markedly enhances cardiac volume, emphasizing its importance in relieving mediastinal compression. Pulmonary volumes remain largely unaffected, suggesting that PE primarily impacts cardiac structures. Our approach to the volumetric measurements provides valuable insights into the physiological outcomes of chest wall remodeling and is considered to be a good modality for future studies to enhance our understanding of the functional benefits of PE repair.

Background/Objectives: The primary objective of PE repair is to relieve compression exerted on the cardiac and pulmonary structures and enhance the thoracic cavity volume. However, the volumetric study of the thoracic cavity, including the heart and lung volumes were scarce. This study seeks to systematically evaluate the volumetric changes in these structures to assess the physiological impact obtained by PE repair. Methods: A retrospective analysis was conducted on 63 patients who underwent PE repair using the XI bar technique from April 2023 to February 2024. Volumetric changes were measured preoperatively and postoperatively using SYNAPSE 3D imaging software (Fujifilm, Tokyo, Japan). Cardiac and pulmonary volumes were quantified, and CT indexes (Haller index, Depression index) were assessed. Complication rates, reoperation rates, and length of hospital stay were also analyzed. Results: The mean cardiac volume increased significantly from 458.25 ml preoperatively to 499.13 ml postoperatively (p=0.018), reflecting an 8.9% increase. Pulmonary volumes, however, showed no statistically significant change, remaining stable at approximately 4371.31ml preoperatively and 4266.87ml postoperatively (p=0.57). Conclusions: Repairing PE markedly enhances cardiac volume, emphasizing its importance in relieving mediastinal compression. Pulmonary volumes remain largely unaffected, suggesting that PE primarily impacts cardiac structures. Our approach with the volumetric measurements provide valuable insights into the physiological outcomes of chest wall remodeling and considered to be a good modality for future studies to enhance our understanding of the functional benefits of PE repair.

Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A prospective randomized controlled study was conducted on children aged 3–6 years scheduled for elective MIRPE. Patients were randomized into either a routine overnight fasting group (NPO) or a clear liquid group. The incidence and severity of emergence delirium (ED) were assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales at recovery room. Postoperative pain scores and opioid requirements were evaluated at intervals of 1–6 h, 6–12 h, and 12–24 h after surgery. Results: Fasting time was 178.6 ± 149.5 min and 608.9 ± 148.4 min in the clear liquid group compared and NPO group, respectively. The incidence of ED, measured by PAED and Watcha scales, was lower in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%, p = 0.037; Watcha score ≥ 3: 51.9% vs. 85.2%, p = 0.019). The highest PAED score recorded in the recovery room was significantly lower in the clear liquid group (11.4 ± 2.8 vs. 14.6 ± 2.8, p < 0.001). Clear liquid group showed significantly lower pain scores at 1–6, 6–12, and 12–24 h postoperatively. Additionally, clear liquid group had lower opioid requirement at 1–6 and 6–12 h postoperatively. Conclusions: Preoperative clear liquid consumption was associated with a lower incidence of ED in pediatric patients undergoing MIRPE.

Eun Seok Ka, M.D., Gong Min Rim, M.D., Seungyoun Kang, M.D., Saemi Bae, M.D., Il-Tae Jang, M.D., Hyung Joo Park, Ph.D., M.D.. J Chest Surg -0001;0:. https://doi.org/10.5090/jcs.23.139

Introduction: Conventional postoperative pain management using an intravenous (IV) patient-controlled approach or thoracic epidural analgesia is suboptimal following minimally invasive repair of the pectus excavatum (MIRPE). Recently, cryoanalgesia has gained popularity owing to its superior pain control outcomes compared to those associated with conventional methods. However, because of its invasiveness, additional instrumentation requirement, and limited effect at early postoperative periods, we hypothesized that serratus anterior plane block (SAPB) could be an effective method for post-repair pain management and a possibly superior alternative.Methods: We conducted a retrospective cohort study of pediatric patients who had undergone MIRPE between March 2022 and August 2023. We compared the efficacy of pain control in three groups among 74 patients: Group N (conventional pain management, n = 24), Group C (cryoanalgesia, n = 24), and Group S (SAPB, n = 26). Group N received IV patient-controlled analgesia (PCA) and a subcutaneous local anesthetic infusion. Group C received bilateral cryoanalgesia on the fourth and seventh intercostal nerves using a cryoprobe at −80°C for 2 min during the operation and IV-PCA postoperatively. Group S received continuous bilateral SAPB with 0.25% ropivacaine and IV-PCA. The pain levels were measured using the visual analog scale (VAS; resting and dynamic), and the total IV rescue analgesic consumption was determined.Results: The three groups had similar baseline characteristics. Group S showed significantly less pain throughout the immediate postoperative course, resting VAS score at 3 h (Group N, 7.21 vs. Group C, 5.75 vs. Group S, 3.81; p < 0.001), and prominent less total IV rescue analgesic consumption (Group N, 116.16 mg vs. Group C, 52.75 mg vs. Group S, 16.61 mg; p < 0.001).Conclusion: SAPB resulted in better postoperative pain control than that associated with cryoanalgesia and conventional pain management after pectus excavatum repair, As it was effective in the immediate postoperative period, achieving a VAS score of <4 points (moderate pain) at 3 h postoperatively, it may play an important role and replace invasive cryoanalgesia in the management of pain after pectus surgery.

Introduction: The conventional technique for pectus excavatum repair was pushing up the depressed chest wall by turning over the convexity of the bent pectus bar. We developed a new concept in which a total crane lift was used as the source of power to elevate the depressed sternum without using pectus bar leverage. This study aims to verify the efficacy of exclusively crane-powered pectus excavatum repair in recent years.Methods: Among the 3622 pectus deformity repairs since 1999, 691 cases repaired with the total crane power between 2017 and 2022 were enrolled. The mean age was 12.0 years (3–45). The operative technique involved wire/screw crane elevation of the sternum, the entire chest wall remodeling with the cross or parallel bars, the bridge/claw bar fixations, and other adjunctive techniques. Outcome analysis included morphological variations, patterns of pectus bar placement, and complication rates.Results: The crane technique and pectoscopy (100%) were used. The bar placements were parallel (22.0%) and cross-bar (47.5%). The bar fixations were the claw fixators for a single bar (30.5%) and the bridge plates for multiple bars (69.5%). The flare-buster and magic strings were liberally used. No serious complications or catastrophic events occurred, but minor complications occurred in 16.9%: pneumothorax in 7.4% (51), pleural effusion in 1.6% (11), and wound problems in 0.4% (3). There was no case of bar displacement.Discussion: The crane-powered pectus excavatum repair showed excellent results with minimal complications and no bar displacement. This innovative approach, part of the NeoPectus surgery, represents a significant advancement in correcting pectus excavatum deformities by utilizing a crane machine to elevate the chest wall.