Surgeons develop new surgical procedure to treat children with severe chest wall anomalies

On November 15, Emeraude, age 17, underwent a complex, hybrid operation developed by surgeons at the Montreal Children's Hospital (MCH) to correct a rare congenital chest wall anomaly called pectus arcuatum. This condition is due to a misalignment of the different sections of the sternum, a bone located in the middle of the chest. The anomaly makes the chest resemble steer horns.

Pectus arcuatum is rare. Milder presentations of the anomaly can be observed, but more severe forms can have a significant psychological impact on teenagers. To help patients with pectus arcuatum, two of the MCH’s pediatric surgeons, Dr. Sherif Emil and Dr. Jean-Martin Laberge, created a new surgical procedure.

They modified the old Ravitch procedure and combined it with a new minimally invasive technique called the Nuss. Thanks to the MCH’s innovative spirit and knowledge of traditional surgical methods, the new hybrid procedure achieves excellent alignment, which can be life-changing for patients like Emeraude.

Briefly, this surgical correction is performed by "breaking and resetting the sternum, and then bracing it by using a metallic bar which crosses the chest from right to left". The complex surgery lasts approximately five to six hours.

As one can expect, the surgery is very painful. Children used to spend four to six days in the hospital and would be sent home with a prescription for opioids. This all changed in June 2022 when the MCH started to use cryoablation for pain management. Generally, children now spend 24-48 hours in hospital.

Freezing out the pain

To dramatically reduce Emeraude’s postoperative pain and for the need to prescribe narcotics and to shorten her postoperative hospital stay, the MCH's surgeons used cryoablation for pain control. Dr. Hussein Wissanji, a pediatric surgeon at the MCH, championed the initiation of this technology. The MCH and the team at the Shriners Hospital for Children – Canada are the only hospitals in Quebec using cryoablation.

With this treatment, surgeons use a specially designed cryoprobe filled with liquid nitrogen at -60 degrees Celsius to freeze the intercostal nerves producing long-lasting pain relief. The nerves gradually regenerate, and normal sensation returns within a few months. Cryoablation allows most patients to go home the day after surgery.

Surgeons Jean-Martin Laberge and Hussein Wissanji performed the procedure on Emeraude on November 15.

The first and busiest Chest Wall Anomaly Center in Canada

Over the years, Emeraude has seen one doctor after another, searching for someone to correct her chest wall anomaly. Unfortunately, she was told her the condition was untreatable, or unnecessary because it was merely a cosmetic procedure. However, the anomaly affected her self-esteem and self-confidence. Undaunted, she kept looking for help.

Then she discovered Canada's first and one of the busiest chest wall anomaly clinics.

The Centre opened in 2011 at the Shriners Hospital for Children – Canada and is a joint Montreal Children’s Hospital and Shriners Hospital for Children - Canada initiative. In addition to providing state-of-the-art clinical services, the Centre has been very productive in the research and education of patients and physicians. It has introduced several new procedures and treatments to patients in Quebec and Canada. It has also produced a large number of scientific publications to share its knowledge with physicians and surgeons worldwide.

If you'd like to listen to a report from Radio-Canada on cryoablation, click here.