Eur J Pediatr Surg
DOI: 10.1055/a-1868-6224

1   Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal (Ringgold ID: RIN285211)

2   Faculty of Medicine, University of Porto, Porto, Portugal (Ringgold ID: RIN26706)

,

3   Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal (Ringgold ID: RIN285211)

,

José Fontoura-Matias

1   Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal (Ringgold ID: RIN285211)

2   Faculty of Medicine, University of Porto, Porto, Portugal (Ringgold ID: RIN26706)

,

Nuno Preto-Gomes

4   Department of Dermatology, Centro Hospitalar Universitário de São João, Porto, Portugal (Ringgold ID: RIN285211)

,

Ana Marinho-Cunha

4   Department of Dermatology, Centro Hospitalar Universitário de São João, Porto, Portugal (Ringgold ID: RIN285211)

,

Miguel Soares-Oliveira

3   Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal (Ringgold ID: RIN285211)

Introduction: Nuss procedure is the main reason for metal implants use by pediatric and thoracic surgeons. There is an ongoing debate on how to avoid allergic complications. Herein we describe our eight-year experience with systematic preoperative metal patch testing and our selective titanium bar use in Nuss procedure. Materials and Methods: Single center retrospective observational cohort study of patients who underwent the Nuss procedure from 2013 to 2020. Preoperative metal patch testing was done in all cases. Criteria for titanium bar utilization were: a positive test for a major component of the stainless-steel bar; or a positive metal patch test and a positive history of atopy, food or metal allergy, or previous allergic reaction to an implant or device. Results: 56 patients were included. Most were male (91.1%) with a median age of 15.0 [13.0-22.0] years old. 19.6% had a positive preoperative metal patch test and 54.5% of these had no personal history of atopy. Stainless-steel bars were used in 27.3% of those patients and titanium bars were used in 72.7%. One patient had a documented minor allergy reaction. None of the 56 patients required early bar removal. Conclusions: Our study suggests that routine preoperative allergy testing and a judicious use of titanium bar is safe and avoids metal allergic complications.

Received: 10 March 2022

Accepted: 31 May 2022

Accepted Manuscript online:
03 June 2022

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