Surgical treatment of congenital chest wall anomalies

Svrha ovog rada je prikazati etiologiju, kliničku sliku, radiološku dijagnostiku te kirurške mogućnosti liječenja kongenitalnih anomalija prsnog koša s posebnim osvrtom na suvremeni kirurški postupak liječenja minimalno invazivnom metodom. U kongenitalne anomalije prsnog koša ubrajamo rascjep prsne kosti, ljevkasta prsa, kokošja prsa, vratno rebro, aplaziju rebra te Polandov sindrom. Ljevkasta prsa su najčešća kongenitalna anomalija prsnog koša s učestalošću od 1:400 do 1:1000 novorođene djece. Anomalija je posljedica pomaka prsne kosti prema kralježnici, najčešće njezina ksifoidnog nastavka iako je katkad deformacijom zahvaćen i manubrijum. Kirurški zahvat, koji se može učiniti operativnom metodom po Sulamii ili minimalno invazivnom operativnom metodom po Nuss-u, može biti indiciran zbog izraženih simptoma od strane kardiovaskularnog i respiratornog sustava ili zbog psiholoških, kozmetičkih i socijalnih problema koje ova anomalija izaziva, posebice u skupini adolescenata, kada dolazi do izrazitog rasta i pogoršanja deformiteta. Uvođenjem minimalno invazivne operativne metode po Nuss-u, koja se na Klinici za dječju kirurgiju Klinike za dječje bolesti Zagreb počela primjenjivati od 2001. godine, klasične operacijske tehnike postale su dio prošlosti.The aim of this study is to describe the etiology, clinical presentation, radiographic diagnostics and surgical treatment options of congenital anomalies of the chest wall with special emphasis on contemporary surgical procedures by minimally invasive method. Congenital anomalies of the thorax include cleft sternum, funnel chest, pigeon chest, cervical rib, rib aplasia and Poland's Syndrome. Funnel chest is the most common congenital anomaly of the chest wall occurring in 1:400 to 1:1000 newborns. This anomaly is the result of the backward displacement of the sternum, usually the xiphoid process, towards the spine, although the manubrium can sometimes be affected by the deformation as well. Surgical procedure, which may be done by the Sulamii method or by the minimally invasive Nuss method, can be indicated in excessive expression of cardiovascular and respiratory symptoms, or due to psychological, social and cosmetic problems caused by such an anomaly. This is seen most prominently in the adolescent age group where profound growth occurs, with worsening of the deformity. By introducing the minimally invasive Nuss procedure, implemented at the Department of Pediatric Surgery, Children's Clinical Hospital Zagreb since 2001, classical surgical techniques have since become a part of the past