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Initial outcomes using cryoablation in surgical management of slipping rib syndrome

      Highlights

      • Cryoablation can be safely performed extra-thoracically during cartilaginous rib excision for slipping rib syndrome.
      • Cryoablation decreases opioid use and hospital length of stay following cartilaginous rib excision.
      • Ablation to T9 and/or T10 extra-thoracically does not lead to abdominal wall laxity.

      Abstract

      Introduction

      Minimally invasive repair of pectus excavatum (MIRPE) and cartilaginous rib excision (CRE) for slipping rib syndrome (SRS) are painful procedures. Intercostal nerve cryoablation (Cryo) controls pain and decreases opioid use in MIRPE. Herein, we describe our experience with cryoablation in CRE.

      Methods

      A retrospective chart review was performed of all patients undergoing CRE between 2018 and 2022. Data on demographics, clinical characteristics, operative details, and hospital course were collected.

      Results

      A total of 98 patients underwent CRE: 68 CRE without cryo, 22 CRE+Cryo, and 8 combined MIRPE+CRE+Cryo. Ninety percent of patients underwent bioabsorbable rib plating. Patients were predominantly female (79%, 73%, 50% respectively) with median ages 17.6, 16.9, and 14.2 years respectively. CRE+Cryo patients used significantly less opioids in hospital (0.6 OME/kg [0.1,1.2]) compared to CRE without cryo (1.0 OME/kg [0.6,2.1]), p<0.05. The median length of stay (LOS) in CRE+Cryo was 1 day [
      • McMahon L.E.
      Slipping Rib Syndrome: A review of evaluation, diagnosis and treatment.
      ,
      • Foley Davelaar C.M.
      A Clinical Review of Slipping Rib Syndrome.
      ] compared to 2 days in CRE without cryo [
      • McMahon L.E.
      Slipping Rib Syndrome: A review of evaluation, diagnosis and treatment.
      ,
      • Foley Davelaar C.M.
      A Clinical Review of Slipping Rib Syndrome.
      ], p=0.09. MIRPE+CRE+Cryo patients used 0.6 OME/kg [0.2,8.0] with a 2 day [1,5.5] LOS. Ninety-one percent of Cryo patients had cryoablation of T9 and/or T10 intercostal nerves, with no documented abdominal wall laxity at median follow-up of 16 days. Cryo was applied extra-thoracically in CRE+cryo without thoracoscopy or lung isolation, while MIRPE+CRE+Cryo used a combination extra-/intra-thoracic cryoablation in with thoracoscopy.

      Conclusion

      Intercostal nerve cryoablation reduces opioid use and LOS in patients undergoing cartilaginous rib excision for slipping rib syndrome. Cryotherapy to as low as T10 did not result in abdominal wall laxity and can be applied extra-thoracically without the need for thoracoscopy. Ongoing prospective studies are required to assess the long-term outcomes.

      Level of evidence

      III.

      Keywords

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