WOFAPS 2025 8th World Congress of Pediatric Surgery

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Poster - 51

Exploration of urinary metals after pectus bar placement

Julio César Moreno Alfonso 1, Esther Comajuncosas Pérez 1, Ada Molina Caballero 1, Sara Hernández Martín 1, Susana Echechipía Madoz 2, Alberto Pérez Martínez 1
1 Hospital Universitario de Navarra. Department of Pediatric Surgery. Pamplona; Spain
2 Hospital Universitario de Navarra. Allergology Department. Pamplona; Spain

Aim of the Study: To investigate the presence of urinary metals in patients with a pectus bar implant.

Methods: A prospective study was conducted on patients undergoing pectus bar removal starting October 2024 at a pediatric hospital. Urinary levels of nickel, vanadium, molybdenum, and chromium were measured on the day of surgery (D0), the first postoperative day (D1), and three months later (M3). Consent was obtained from patients and/ or legal guardians.

Results: Five patients (mean age 13 ± 1.2 years; 3 females, 2 males) were included. Nickel was the most elevated metal with an average level of 5.4 mcg/L ± 2.6 on D0 (reference range [RR]: 0–5.0 mcg/L), increasing to 8.8 mcg/L ± 8 on D1 (p=0.686). Molybdenum levels on D0 were near the upper limit of normal (89 mcg/L ± 26.9; RR: 10–124 mcg/L) but dropped substantially on D1 (23.8 mcg/L ± 11.8; p=0.043). Vanadium and chromium showed no significant changes. At this time, samples from the three-month follow-up are only available for two patients, one of whom shows progressive nickel clearance (D0 9.2; D1 7.4; and M3 5.3 mcg/L).

Conclusions: Patients with thoracoplasty bars may develop metallosis, evidenced by dark tissue discoloration and urinary metal excretion. This could contribute to metal sensitization and hypersensitivity reactions in some cases. Nickel was the most elevated metal in urine, with levels rising further after surgical manipulation, suggesting implant mobilization may exacerbate metal release. These preliminary findings highlight the need for perioperative allergy assessment and careful selection of implant materials. Further research is required to establish long-term implications.

Keywords: Pectus, Nuss procedure, Metallosis, Thorax, Allergy

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