Clinical Experience of Nuss Procedure for Pectus Excavatum in Adult Female Patients

Fang, Fu-Chi; Cheng, Yeung-Leung; Lee, S. C.; Chen, J. C.; Hsu, Hsian Her; Tzao, Ching

doi:10.1055/s-2008-1038631

Cited by 13 publications

(3 citation statements)

References 12 publications

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“…This may coincide with the low percentage of Nuss procedures performed in females in a number of studies. In a study by Fang and his colleagues, 14 only 15 (12%) of 126 consecutive adult patients who had the Nuss procedure at their hospital were adult females, who had a mean age of 24 years. This is not in line with the typical male:female ratio for PE.…”

Section: Discussionmentioning

confidence: 99%

Choosing between the modified Ravitch and Nuss procedures for pectus excavatum: Considering the patients’s perspective

Elsayed

Hassaballa

Hady

et al. 2016

annals

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INTRODUCTION Pectus excavatum (PE) is the most common paediatric chest wall deformity. The majority of patients are treated for cosmetic purposes, with the modified Ravitch and Nuss procedures the most commonly performed. We tested the preferences of healthy individuals over their choice of procedure. METHODS The study was conducted from February to August 2014. A five-item illustrated questionnaire was administered to teenagers and young adults aged 14-26 years over their willingness to seek medical advice if they had PE, provided its cosmetic appearance was the only complaint. They were asked about their preference over the modified Ravitch and Nuss procedures, with the surgical details for both procedures explained by medical professionals, alongside illustrated outcomes. RESULTS Two hundred and two healthy individuals were interviewed. The median age was 19.5 years (14-26 years) and 141 (69.8%) were male. Sixty seven (33.2%) participants refused any intervention, while 11 (5.4%) initially wanted an intervention but refused after understanding the surgical procedures available. Of the 135 respondents who chose surgical correction, 84 (62.2%) preferred the modified Ravitch operation, while 51 (37.8%) preferred the Nuss procedure. The main reason for choosing the modified Ravitch technique was not having something metal in the chest, while most participants who chose the Nuss procedure felt that it was "cosmetically better". CONCLUSIONS Patients have preferences over the choice of procedure for PE repair that can affect the treatment decision. Paediatric and thoracic surgeons should therefore be experienced in performing both procedures.

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Section: Discussionmentioning

confidence: 99%

Choosing between the modified Ravitch and Nuss procedures for pectus excavatum: Considering the patients’s perspective

Elsayed

Hassaballa

Hady

et al. 2016

annals

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“…The number of bars used in Nuss surgery is primarily determined by the gross appearance of the deformity. But in some cases, such as in women (because of the breasts) and obese patients, the deformity of the bone cage is not completely consistent with the external deformity of the chest wall [13,14].…”

Section: Introductionmentioning

confidence: 99%

The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients

Tzeng

Hsieh

et al. 2020

PLoS ONE

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The Nuss procedure is a minimally invasive repair used to treat pectus excavatum. A bilateral thoracoscopy-assisted approach has been reported as a safe method for Nuss repair. The aim of this observational cohort study is to evaluate the application of the bilateral thoracoscopy-inspection to assist in the selection of the number of bars for correction of the pectus deformity in adolescents and adults. A retrospective chart review was performed on all adolescent and adult patients (296 patients: 257 male, 39 female; aged of 23.9 ± 7.7 years) with pectus excavatum primarily corrected with the modified Nuss repair from August 2014 to January 2018. The patients were divided into three age groups (A: 12 years ≦ age < 19 years, n = 73; B: 19 years ≦ age < 30 years, n = 175; C: age ≧ 30 years, n = 48). Advanced repair of deformed chest walls using more than one bar depended on the change detected via gross and perioperative thoracoscopy-inspection. The results showed that two or three pectus bars were used in 268 patients (90.5%). The overall complication rate after a postoperative follow-up of 28.6 ± 11 months was 6.8% (20/296), without mortality, major bleeding, or serious infectious complications. A multivariate logistic regression analysis showed that the complications were only associated with Haller index (adjusted OR = 1.2935, p = 0.0317) under controlling confounding factors. The postoperative sternovertebral distance was significantly improved from 7.3±1.6 to 10.1± 2.8 cm (p<0.001). The thoracoscopy-assisted approach of Nuss repair for correction of pectus excavatum was safe and effective approach and could also be used as an alternative approach for the selection of placed bars in adolescent and adult patients. Further studies regarding long-term outcomes are required.

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“…For these cases, additional bars should be used. 1,2 Application of additional bars exerts dynamic forces to the thorax at multiple sites, which is advantageous for the correction of thoracic deformity extending to wide regions.…”

mentioning

confidence: 99%

Double-bar application decreases postoperative pain after the Nuss procedure

Nagaso

Miyamoto

Kokaji

et al. 2010

The Journal of Thoracic and Cardiovascular Surgery

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Clinical Experience of Nuss Procedure for Pectus Excavatum in Adult Female Patients

Abstract: The Nuss procedure offers a high satisfaction rate and an acceptable complication rate for PE repair in adult female patients. A subsequent surgery for breast augmentation can be considered after the Nuss repair has stabilized.

Cited by 13 publications

References 12 publications

Choosing between the modified Ravitch and Nuss procedures for pectus excavatum: Considering the patients’s perspective

Choosing between the modified Ravitch and Nuss procedures for pectus excavatum: Considering the patients’s perspective

The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients

Double-bar application decreases postoperative pain after the Nuss procedure

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