Skip to main content
SpringerLink
Log in

Anterior chest wall regression after Nuss bar removal in adult patients with pectus excavatum

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

Pectus excavatum repair with the Nuss procedure can be successfully performed in adults. After removing the pectus bars, the anterior chest wall may regress to some degree. The purpose of this study was to clarify the amount of improvement and regression of the chest wall after bar removal.

Methods

In 45 adult patients who underwent the Nuss procedure, the sternovertebral distance (SVD) on lateral chest X-ray was measured (A) before the Nuss procedure, (B) before bar removal, and (C) after bar removal. The average SVD was compared, and the difference between A and C suggesting final sternal elevation and B and C suggesting regression was calculated. The correlation between the duration of bar in situ and the amount of regression was analyzed.

Results

The average period of bar in situ was 34.9 ± 5.0 (range 23–45) months. The average SVD-A, SVD-B, and SVD-C values were 58.9 ± 20.0, 89.3 ± 19.1, and 81.6 ± 20.1 mm, respectively, with significant differences among them. Final sternal elevation was 22.7 ± 17.4 mm, and average regression was 7.6 ± 8.6 mm. The correlation coefficient between the duration of bar in situ and the amount of regression was 0.119, suggesting no clear correlation.

Conclusions

In spite of some degree of chest wall regression after bar removal, the Nuss procedure was effective for adult patients with pectus excavatum. The period of bar in situ and chest wall regression had little correlation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Nuss D, Kelly RE, Croitoru DP, Katz ME. A 10 year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998;33:545–52.

    Article  CAS  Google Scholar 

  2. Coln D, Gunning T, Ramsay M, Swygert T, Vera R. Early experience with the Nuss minimally invasive correction of pectus excavatum in adults. World J Surg. 2002;26:1217–21.

    Article  Google Scholar 

  3. Pilegaard HK. Extending the use of Nuss procedure in patients older than 30 years. Eur J Cardio-Thoracic Surg. 2011;40:334–7.

    Google Scholar 

  4. Choi S, Park HJ. Complications after pectus excavatum repair using pectus bars in adolescents and adults: Risk comparisons between age and technique groups. Interact Cardiovasc Thorac Surg. 2017;25:606–12.

    Article  Google Scholar 

  5. Aronson DC, Bosgraaf RP, Van Der Horst C, Ekkelkamp S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World J Surg. 2007;31:26–9.

    Article  Google Scholar 

  6. Jaroszewski DE, Ewais MM, Chao CJ, et al. Success of minimally invasive pectus excavatum procedures (modified Nuss) in adult patients (≥30 years). Ann Thorac Surg. 2016;102:993–1003.

    Article  Google Scholar 

  7. Hoksch B, Kocher G, Vollmar P, Praz F, Schmid RA. Nuss procedure for pectus excavatum in adults: long-term results in a prospective observational study. Eur J Cardio-Thoracic Surg. 2016;50:934–9.

    Article  Google Scholar 

  8. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252:1072–81.

    Article  Google Scholar 

  9. Nyboe C, Knudsen MR, Pilegaard HK. Elective pectus bar removal following Nuss procedure for pectus excavatum: a single-institution experience. Eur J Cardio-Thoracic Surg. 2011;39:1040–2.

    Article  Google Scholar 

  10. Park HJ, Kim KS. Pectus bar removal: surgical technique and strategy to avoid complications. J Vis Surg. 2016;2:60.

    Article  Google Scholar 

  11. Kilda A, Lukosevicius S, Barauskas V, Jankauskaite Z, Basevicius A. Radiological changes after Nuss operation for pectus excavatum. Medicina (Kaunas). 2009;45:699–705.

    Article  Google Scholar 

  12. Kuyama H, Uemura S, Yoshida A. Chondrotomy and sternotomy combined with the Nuss procedure for severe asymmetric pectus excavatum: how to do it. Surg Today. 2020. https://doi.org/10.1007/s00595-020-02153-w.

    Article  PubMed  Google Scholar 

  13. Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Ann Cardiothorac Surg. 2016;5:422–33.

    Article  Google Scholar 

  14. Cho DG, Kim JJ, Park JK, Moon SW. Recurrence of pectus excavatum following the Nuss procedure. J Thorac Dis. 2018;10:6201–10.

    Article  Google Scholar 

  15. Kuyama H, Uemura S, Yoshida A. Recurrence of pectus excavatum in long-term follow-up after the Nuss procedure in young children based on the radiographic Haller index. J Pediatr Surg. 2020;55:2699–702.

    Article  Google Scholar 

  16. Metzelder ML, Kuebler JF, Leonhardt J, Ure BM, Petersen C. Self and parental assessment after minimally invasive repair of pectus excavatum: lasting satisfaction after bar removal. Ann Thorac Surg. 2007;83:1844–9.

    Article  Google Scholar 

  17. Gomes-Fonseca J, Vilaça JL, Henriques-Coelho T, Direito-Santos B, Pinho ACM, Fonseca JC. A new methodology for assessment of pectus excavatum correction after bar removal in Nuss procedure: preliminary study. J Pediatr Surg. 2017;52:1089–97.

    Article  Google Scholar 

  18. Rha EY, Kim JH, Yoo G, Ahn S, Lee J, Jeong JY. Changes in thoracic cavity dimensions of pectus excavatum patients following Nuss procedure. J Thorac Dis. 2018;10:4255–61.

    Article  Google Scholar 

  19. Khanna G, Jaju A, Don S, Keys T, Hildebolt CF. Comparison of Haller index values calculated with chest radiographs versus CT for pectus excavatum evaluation. Pediatr Radiol. 2010;40:1763–7.

    Article  Google Scholar 

  20. Nuss D. Minimally invasive surgical repair of pectus excavatum. Semin Pediatr Surg. 2008;17:209–17.

    Article  Google Scholar 

  21. Birkemeier KL, Podberesky DJ, Salisbury S, Serai S. Breathe in… breathe out… stop breathing: does phase of respiration affect the Haller index in patients with pectus excavatum? AJR Am J Roentgenol. 2011;197:W934–9.

    Article  Google Scholar 

  22. Poncet P, Kravarusic D, Richart T, Evison R, Ronsky JL, Alassiri A. Clinical impact of optical imaging with 3-D reconstruction of torso topography in common anterior chest wall anomalies. J Pediatr Surg. 2007;42:898–903.

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank two medical students, Shingo Ueda and Mako Watanabe, for assisting us in data collection and organization.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Hisako Kuyama, Hideki Soh & Atsushi Yoshida

  2. Division of Chest Wall Surgery, Nishinomiya Watanabe Cardiovascular Center, 3-25 Ikeda-Cho, Nishinomiya, Hyogo, 662-0911, Japan

    Sadashige Uemura

Authors
  1. Hisako Kuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sadashige Uemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideki Soh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsushi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hisako Kuyama.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

Approval for this study was obtained from the Research Ethics Committee of Kawasaki Medical School (No. 3660). For this type of retrospective review, consent from each patient was not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuyama, H., Uemura, S., Soh, H. et al. Anterior chest wall regression after Nuss bar removal in adult patients with pectus excavatum. Gen Thorac Cardiovasc Surg 69, 1308–1312 (2021). https://doi.org/10.1007/s11748-021-01635-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-021-01635-z

Keywords

Search

Navigation