Article

World Journal of Surgery

, Volume 31, Issue 1, pp 26-29

Nuss Procedure: Pediatric Surgical Solution for Adults with Pectus Excavatum

  • Daniel C. AronsonAffiliated withPediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC, Academic Medical CenterVrije Universiteit Medical Center Email author 
  • , Remko P. BosgraafAffiliated withPediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC, Academic Medical Center
  • , Chantal van der HorstAffiliated withDepartment of Plastic and Reconstructive Surgery, Academic Medical Center
  • , Seine EkkelkampAffiliated withPediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC, Academic Medical CenterVrije Universiteit Medical Center

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Abstract

Introduction

The aim of the study was to compare results of the Nuss procedure in adults and children.

Methods

The data were collected prospectively. Antibiotic prophylaxis was used in all patients. Differences were tested statistically.

Results

A total of 35 adults (28 men; male/female ratio 4:1) with a median age of 23 years (range 18 years to 47 years 1 month) were included in the study. A previous Welch operation had been performed in one (3%). The median operating time was 65 minutes (range 45–105 minutes). Two bars were inserted in one patient, and stabilizers were used in all. Pneumothorax occurred in 9 (26%), wound abscess in 3 (9%), and bar slips in 5 (14%). The median hospital stay was 7 days (range 4–10 days). Bars were removed in 14 (40%) patients without complications. Follow-up occurred 6 and 12 months after bar removed, at which times no recurrence of the pectus and no sternal protrusions were seen. In the other part of the study, 141 children and adolescents (105 boys; male/female ratio 3:1) with a median age of 13 years (range 4 years 11 months to 17 years 8 months) were included. A previous Welch operation had been performed in five (4%). Two bars were inserted in four, and stabilizers were used in 100 (71%). The median operating time was 65 minutes (40–185 minutes). Pneumothorax occurred in 33 (24%), wound abscess in 1 (0.7%), and bar slips in 18 (13%). The median hospital stay was 7 days (range 5–18 days). Bars were removed in 77 (55%) without complications. Follow-up occurred 6 and 12 months after bar removed, and the last follow-up was eventually planned at the end of growth (age 18). The pectus recurred in one patient with Marfan syndrome, and sternal protrusion occurred in one. Differences between groups were as follows: a significantly higher proportion of adult patients were treated with stabilizers (P < 0.001), and there were significantly more wound abscesses in adults (P < 0.001).

Conclusions

The Nuss procedure is as effective for correcting pectus excavatum in adults as it is in children. However, in adults the bars tended to be less stable, and wound abscesses occurred more frequently.