# Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome — GCMD Library

<p>Another article from the Journal of Pediatric Surgery by Dr. Cecilia Gigena </p>
<p>"Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome"</p>
<p><strong>Authors: </strong><em>Krista Lai, R Scott Eldredge, Melissa Nguyen, Benjamin E. Padilla, Lisa E. McMahon</em></p>
<p><strong>Full article:</strong> <a href="https://gcmd.co/40civ85">https://gcmd.co/40civ85</a></p>
<p><strong>Introduction</strong></p>
<p>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.</p>
<p><strong>Methods</strong></p>
<p>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.</p>
<p><strong>Results</strong></p>
<p>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 [1,2] compared to 2 days in CRE without cryo [1,2], 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.</p>
<p><strong>Conclusion</strong></p>
<p>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.<br>
 </p>

Type: video · 1 min · posted 2023-10-25
Canonical: https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456

## Chapters
- [0:00](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=0) Cryoablation in Slipping Rib Syndrome Surgery

## Statements
- "The study was a retrospective review conducted in Phoenix between 2018 and 2022" — Cecilia Gigena (clinical) [0:11](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=11)
- "The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo" — Cecilia Gigena (clinical) [0:16](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=16)
- "The study included 98 patients total" — Cecilia Gigena (epidemiological) [0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "68 patients underwent resection without cryo" — Cecilia Gigena (epidemiological) [0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "22 patients underwent resection with cryo" — Cecilia Gigena (epidemiological) [0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia" — Cecilia Gigena (epidemiological) [0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "Patients who underwent resection with cryo had significantly less opiate use" — Cecilia Gigena (clinical) [0:43](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)
- "Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant" — Cecilia Gigena (clinical) [0:43](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)

## Transcript
Do you use cryo for resecting cartilage in the slipping ribs syndrome? Hi, I'm Cecilia Jigena from Cincinnati Children's Hospital, and I think this is an article that you should know about. This is a retrospective review done in Phoenix between 2018 and 2022. And they wanted to compare the length of stay and opiate use in patients that underwent cartilaginous rib excision with and without cryo. And what did they find? They had 98 patients, 68 underwent a resection without cryo, 22 underwent a resection with cryo, and 8 underwent a NAS procedure, plus the cartilaginous resection in cryoalgesia. And they found that patients that underwent the resection with cryo had significantly less opiate use and though it's not significant, stay one day less than patients without cryo. Let us know what you think and stay tuned for more articles that you should know about.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai