Surgical correction of the funnel chest deformity in children

Abstract

The aim of this study was to evaluate our results during and after the Nuss operation in children with pectus excavatum. We have performed the Nuss procedure in 128 patients with pectus excavatum since 2001, and 74 patients underwent bar removal. Of the 128 patients 96 were male and 32 were female; age ranged from eight to 21 years with an average of 13.8 years. In 46% of patients psychological reasons for operative treatment were dominant while in the other 54% of patients clinical signs were the indications. Complications in 128 patients included 36 pneumothorax, 28 of which resolved spontaneously. Postoperative pneumonia developed in six patients. In two patients we had infection of the implanted bar, and there were two patients with cellulitis. We had six patients with bar displacement and reoperation was needed. During the Nuss procedure we had one injury of the intercostal artery. We had pericardial tears in two patients without clinical significance. In two patients we had pericardial effusion six months after the Nuss procedure, requiring pericardiocentesis. In one patient we had fracture of the sternum. There were no complications following bar removal. After bar removal in 74 patients, 54 patients (72.9%) maintained excellent results with normal chest anatomy, good results were found in 16 patients (21.6%) with mild residual pectus and poor results in four patients (5.5%) with severe recurrence. Our experience with the Nuss procedure demonstrated excellent results with few minor complications.

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

“…We found no report of improving adult lung function with the Nuss procedure, but found reports of improved long-term lung function in children [ 46 - 48 ]. Investigations in each group reported improved symptoms and cardiac function [ 29 , 41 , 42 , 47 - 49 ].…”

“…Forty-four articles met the criteria for inclusion. These were stratified based on age range and treatment, providing seven subgroups: Nuss adult (n = 8) [ 32 , 35 - 41 ], Nuss pediatric (n = 22) [ 21 , 23 - 25 , 27 , 29 , 30 , 32 , 33 , 35 ],[ 39 , 42 - 52 ], Ravitch adult (n = 3) [ 53 - 55 ], Ravitch pediatric (n = 11) [ 24 , 25 , 27 , 29 , 30 , 55 - 60 ], Robicsek pediatric (n = 2) [ 57 , 61 ], Implant adult (n = 3) [ 18 , 20 , 62 ]. No other treatments had articles that satisfied the inclusion criteria.…”

Late complication of the Nuss procedure: recurrent cardiac tamponade

“…In general, complications caused by the Ravitch procedure and Nuss bar implantation can be classified as acute and chronic complications, based on 30 days after the surgical procedure [8,9], and life-threatening events, such as cardiac perforation and other direct heart or aortic injuries have mostly occurred acutely during still bar placement. Pericarditis and pericardial effusion are rare complications that can develop later; however, progression to life-threatening cardiac tamponade is extremely rare [4-6]. The cases presented with tamponade were mostly related to sternal wire after the Ravitch procedure [10-12] or Nuss bar displacement injuring the ascending aorta [13] or pericardium [14].…”

“…This procedure elevates the depressed sternum by passing a suitably shaped, concave steel bar beneath the sternum, resting on the outer aspects of the ribs on each side under thoracoscopic guidance [3]. Pericarditis or pericardial effusions as one of the postoperative complications have been reported in 1.6–2.4% of cases [4-6], but progression to cardiac tamponade is very rare.…”