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

Abstract

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.

Massive right heart thrombus after the Nuss procedure: A case report

“…Concomitant procedures, including costal cartilage resection, multiple bar placement, and sternal osteotomy, are often required to eliminate the extrinsic compression and deformation effects of a rigid chest wall on the right heart and outflow tract. 2 In our previous experience, the incidence of bar displacement requiring reintervention was 3.4%, 5 but no incidence of cardiac thrombi was observed. After comprehensive literature searches, we did not find a similar case report describing such a causal relationship among the Nuss bar migration, right heart compression, and massive intracardiac thrombosis.…”

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

“…The Nuss procedure is the most common and most preferred treatment for operative correction of pectus excavatum deformities. 10 11 However, variations in operative techniques are common and may be due to multiple factors such as patient characteristics, surgeon experience, and institution protocols. Our study is the largest retrospective review to analyze these variations in operative techniques and the resulting differences in postoperative outcomes and has several important novel conclusions.…”

“…8,9 Patient characteristics such as age, Haller index (HI), asymmetrical or long deformities, and comorbid connective tissue disease, in addition to surgeon experience and preference, guide intraoperative decision-making in placing multiple bars. 10 The Nuss procedure has become safer since its inception and provides excellent long-term results and patient satisfaction. 5 Although complication rates continue to decrease, identification and prevention of early and late complications remain important.…”

“…8 9 Patient characteristics such as age, Haller index (HI), asymmetrical or long deformities, and comorbid connective tissue disease, in addition to surgeon experience and preference, guide intraoperative decision-making in placing multiple bars. 10…”

Biomechanical modeling and problematic issues of surgical correction of congenital funnel chest deformity

“…Торакопластика за методикою D. Nuss є найпоширенішим способом лікування ВЛДГК, вважається мінінвазивною технологією і дає швидкий косметичний ефект. У ході оперативного втручання лійкоподібна деформація усувається за допомогою установки пластини за грудиною, яка фіксується до ребер у необхідному положенні, інколи використовується декілька пластин [9,15,18].…”