Long-Term Sensory Function 3 years after Minimally Invasive Repair of Pectus Excavatum with Cryoablation

Infographic · Jun 2024 · 1 min read

In brief

Three-year follow-up study of 47 pediatric patients after minimally invasive pectus excavatum repair with intercostal nerve cryoablation. Nearly half (46.8%) had residual chest wall hypoesthesia affecting <6% of treated area; 13% reported mild neuropathic symptoms requiring no treatment, demonstrating favorable long-term sensory outcomes.

Cryoablation during MIRPE reduces hospital stay and opioid use while maintaining good long-term sensory outcomes at 3 years post-op.
47% of patients had detectable hypoesthesia at bar removal, but it affected only 4-6% of treated chest wall surface area on average.
Sensory changes were limited to 1-2 dermatomes in most cases, with T5 being the most commonly affected level.
Chronic neuropathic pain was rare (13% reported symptoms) and none required treatment, suggesting cryoablation is safe long-term.
Hypoesthesia patterns were similar across cold, soft touch, and pinprick modalities, indicating consistent nerve recovery profiles.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The left column shows balloon dilation, the middle shows Heller myotomy, and the right shows POEM procedure. Success rates are prominently displayed with percentage values.

New Infographic from the Journal of Pediatric Surgery by Kim Priban RN

"Long-Term Sensory Function 3 years after Minimally Invasive Repair of Pectus Excavatum with Cryoablation"

Authors: R Scott Eldredge, Brielle Ochoa, Emily Khoury, Kristin Mihalcin, Daniel Ostlie, Justin Lee, Lisa McMahon, David Notrica, Benjamin E. Padilla

Full article: https://gcmd.co/3wATBod

Introduction

Minimally invasive repair of pectus excavatum (MIRPE) with intercostal nerve cryoablation (Cryo) decreases length of hospitalization and opioid use, but long-term recovery of sensation has been poorly described. The purpose of this study was to quantify long-term hypoesthesia and neuropathic pain after MIRPE with Cryo.

Methods

A prospective cohort study was conducted single-institution of patients ≤21 years who presented for bar removal. Consented patients underwent chest wall sensory testing and completed neuropathic pain screening. Chest wall hypoesthesia to cold, soft touch, and pinprick were measured as the percent of the treated anterior chest wall surface area (TACWSA); neuropathic pain was evaluated by questionnaire.

Results

The study enrolled 47 patients; 87% male; median age 18.4 years. The median bar dwell time was 2.9 years. A median of 2 bars were placed; 80.9% were secured with pericostal sutures. At enrollment, 46.8% of patients had identifiable chest wall hypoesthesia. The mean percentage of TACWSA with hypoesthesia was 4.7 ± 9.3% (cold), 3.9 ± 7.7% (soft touch), and 5.9 ± 11.8% (pinprick). Hypoesthesia to cold was found in 0 dermatomes in 62%, 1 dermatome in 11%, 2 dermatomes in 17% and ≥3 dermatomes in 11%. T5 was the most common dermatome with hypoesthesia. Neuropathic symptoms were identified by 13% of patients; none required treatment.

Conclusions

In long-term follow up after MIRPE with Cryo, 46.8% of patients experienced some chest wall hypoesthesia; the average TACWSA with hypoesthesia was 4–6%. Hypoesthesia was mostly limited to 1–2 dermatomes, most commonly T5. Chronic symptomatic neuropathic pain was rare.

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