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Peer-reviewedCC BY 4.0Surgical Case Reports

Lung Transplantation with Planned Delayed Chest Closure in Severe Pectus Excavatum after Multiple Pleurodeses: A Case Report

  • Yusuke Nakano1
  • Tatsuaki Watanabe1
  • Hirotsugu Notsuda1
  • Takuya Ikushima1
  • Sakiko Kumata1
  • Ken Onodera1
  • Yui Watanabe1
  • Takashi Hirama1,2
  • Takaya Suzuki1
  • Hisashi Oishi1
  • Takashi Kochi3
  • Yoshinori Okada1,2
  1. 1Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
  2. 2Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan
  3. 3Department of Plastic and Reconstructive Surgery, Sendai City Hospital, Sendai, Miyagi, Japan
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Abstract

INTRODUCTION: Lung transplantation combined with pectus excavatum repair has been reported in selected patients with severe pectus excavatum to expand the restricted thoracic cavity and facilitate graft accommodation. However, the safe implementation of this surgical strategy may be challenging in patients with extensive pleural adhesions after repeated pleurodeses, because of the increased risk of postoperative bleeding and re-thoracotomy.

CASE PRESENTATION: A 15-year-old boy with interstitial lung disease, secondary pulmonary hypertension, severe pectus excavatum, and multiple prior bilateral pleurodeses underwent deceased-donor bilateral lung transplantation using a planned delayed chest closure (DCC) strategy. Preoperative CT showed marked thoracic deformity with a Haller index of 9.1 and a leftward mediastinal shift. Because extensive pleural adhesions were expected to complicate graft implantation and hemostasis and increase the risk of re-thoracotomy for postoperative bleeding, a 2-stage strategy consisting of planned DCC followed by pectus bar placement at definitive chest closure was established at the time of transplant listing in collaboration with an external pectus specialist. Bilateral lung transplantation was performed under venoarterial extracorporeal membrane oxygenation support, followed by temporary chest closure. At the second-stage operation on POD 2, 2 pectus bars were placed, and additional graft volume reduction was performed, allowing definitive chest closure without hemodynamic compromise. The patient was discharged home on POD 69 without wound complications or implant-related infections.

CONCLUSIONS: This case suggests that lung transplantation may be feasible in carefully selected patients with severe pectus excavatum and extensive pleural adhesions, with appropriate multidisciplinary planning. A preplanned 2-stage strategy incorporating DCC and pectus bar placement at definitive chest closure represents a potential option for such complex cases.

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Cite

BibTeXRIS
BibTeX
@article{nakano2026lung,
  title = {{Lung Transplantation with Planned Delayed Chest Closure in Severe Pectus Excavatum after Multiple Pleurodeses: A Case Report}},
  author = {Yusuke Nakano and Tatsuaki Watanabe and Hirotsugu Notsuda and Takuya Ikushima and Sakiko Kumata and Ken Onodera and Yui Watanabe and Takashi Hirama and Takaya Suzuki and Hisashi Oishi and Takashi Kochi and Yoshinori Okada},
  journal = {Surgical Case Reports},
  year = {2026},
  month = oct,
  doi = {10.70352/scrj.cr.26-0685},
  url = {https://doi.org/10.70352/scrj.cr.26-0685},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Lung Transplantation with Planned Delayed Chest Closure in Severe Pectus Excavatum after Multiple Pleurodeses: A Case Report
AU  - Yusuke Nakano
AU  - Tatsuaki Watanabe
AU  - Hirotsugu Notsuda
AU  - Takuya Ikushima
AU  - Sakiko Kumata
AU  - Ken Onodera
AU  - Yui Watanabe
AU  - Takashi Hirama
AU  - Takaya Suzuki
AU  - Hisashi Oishi
AU  - Takashi Kochi
AU  - Yoshinori Okada
PY  - 2026
DA  - 2026/10/31
JO  - Surgical Case Reports
DO  - 10.70352/scrj.cr.26-0685
UR  - https://doi.org/10.70352/scrj.cr.26-0685
AB  - INTRODUCTION: Lung transplantation combined with pectus excavatum repair has been reported in selected patients with severe pectus excavatum to expand the restricted thoracic cavity and facilitate graft accommodation. However, the safe implementation of this surgical strategy may be challenging in patients with extensive pleural adhesions after repeated pleurodeses, because of the increased risk of postoperative bleeding and re-thoracotomy.  CASE PRESENTATION: A 15-year-old boy with interstitial lung disease, secondary pulmonary hypertension, severe pectus excavatum, and multiple prior bilateral pleurodeses underwent deceased-donor bilateral lung transplantation using a planned delayed chest closure (DCC) strategy. Preoperative CT showed marked thoracic deformity with a Haller index of 9.1 and a leftward mediastinal shift. Because extensive pleural adhesions were expected to complicate graft implantation and hemostasis and increase the risk of re-thoracotomy for postoperative bleeding, a 2-stage strategy consisting of planned DCC followed by pectus bar placement at definitive chest closure was established at the time of transplant listing in collaboration with an external pectus specialist. Bilateral lung transplantation was performed under venoarterial extracorporeal membrane oxygenation support, followed by temporary chest closure. At the second-stage operation on POD 2, 2 pectus bars were placed, and additional graft volume reduction was performed, allowing definitive chest closure without hemodynamic compromise. The patient was discharged home on POD 69 without wound complications or implant-related infections.  CONCLUSIONS: This case suggests that lung transplantation may be feasible in carefully selected patients with severe pectus excavatum and extensive pleural adhesions, with appropriate multidisciplinary planning. A preplanned 2-stage strategy incorporating DCC and pectus bar placement at definitive chest closure represents a potential option for such complex cases.
SN  - 2198-7793
ER  -