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Surgical Correction of Pectus Excavatum by the Nuss Procedure: A 15-Year Experience Study

  • Piotr Cierpikowski
  • Adam Rzechonek
  • Piotr Błasiak
  • Hanna Lisowska
  • Grzegorz Pniewski
  • Patric Le Pivert
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1047)

Abstract

Pectus excavatum is the most common congenital deformity of the chest. The Nuss procedure is minimally invasive surgical correction of this defect, using retrosternal metal bars. The purpose of the present study was to describe a 15-year experience with the Nuss surgery, and to evaluate the long-term clinical results of the procedure. We retrospectively evaluated 239 patients, aged 14–34, who underwent the Nuss surgery in the years 2002–2016. Postoperative complications were observed in 40/236 (16.9%) patients. The most common complication was pneumothorax in 14/239 patients. Less common were the following: wound infection in 4, pleural effusion in 3, allergy to nickel in 1, lung atelectasis in 1, and ventricular failure in 1 patient. Three patients were treated because of severe postoperative pain, and in one case the implant had to be removed. Postoperative complications associated with the number of bars inserted, but not with the patient age or gender. A satisfactory and long lasting corrective effect of surgery was observed in 231/239 (96.7%) of patients. There was no perioperative mortality. We conclude that the Nuss surgery is a safe surgery that demonstrates excellent and long-lasting esthetic results, with a low risk of severe complications.

Keywords

Chest wall Congenital deformity Nuss procedure Pectus excavatum Pneumothorax Postoperative complications 

Notes

Acknowledgments

This study was supported by the statutory budget of Wroclaw Medical University in Poland

Conflict of Interest

The authors declare no conflicts of interest in relation to this article.

References

  1. Antonoff M, Alexandra E, Erickson A, Hess D, Robert D, Acton R (2009) When patients choose: comparison of Nuss, Rawitch, and Leonard procedures for primary repair of pectus excavatum. J Pediatr Surg 44:1113–1119CrossRefPubMedGoogle Scholar
  2. Bilgi Z, Ermerak NO, Çetinkaya Ç, Laçin T, Yüksel M (2017) Risk of serious perioperative complications with removal of double bars following the Nuss procedure. Interact Cardiovasc Thorac Surg 24(2):257–259PubMedGoogle Scholar
  3. Cartoski MJ, Nuss D, Goretsky MJ, Proud VK, Croitoru DP, Gustin T, Mitchell K, Vasser E, Kelly RE Jr (2006) Classification of the dysmorphology of pectus excavatum. J Pediatr Surg 41(9):1573–1581CrossRefPubMedGoogle Scholar
  4. Cobben JM, Oostra RJ, van Dijk FS (2014) Pectus excavatum and carinatum. Eur J Med Genet 57(8):414–417CrossRefPubMedGoogle Scholar
  5. Dzielicki J, Korlacki W, Janicka I, Dzielicka E (2006) Difficulties and limitations in minimally invasive repair of pectus excavatum – 6 years experiences with Nuss technique. Eur J Cardiothorac Surg 30(5):801–804CrossRefPubMedGoogle Scholar
  6. Engum S, Rescorla F, West K, Rouse T, Scherer LR, Grosfeld J (2000) Is the grass greener? Early results of the Nuss procedure. J Pediatr Surg 35(2):246–251CrossRefPubMedGoogle Scholar
  7. Fonkalsrud EW (2003) Current management of pectus excavatum. World J Surg 27(5):502–508CrossRefPubMedGoogle Scholar
  8. Hebra A, Gauderer MW, Tagge EP, Adamson WT, Othersen HB Jr (2001) A simple technique for preventing bar displacement with the Nuss repair of pectus excavatum. J Pediatr Surg 36(8):1266–1268CrossRefPubMedGoogle Scholar
  9. Hosie S, Sitkiewicz T, Petersen C, Gobel P (2002) Minimally invasive repair of pectus excavatum – the Nuss procedure. A European multicentre experience. Eur J Pediatr Surg 12(4):235–238CrossRefPubMedGoogle Scholar
  10. Jacobs JP, Quintessenza JA, Morell VO, Botero LM, van Gelder HM, Tchervenkov CI (2002) Minimally invasive endoscopic repair of pectus excavatum. Eur J Cardiothorac Surg 21(5):869–873CrossRefPubMedGoogle Scholar
  11. Jo WM, Choi YH, Sohn YS, Kim HJ, Hwang JJ, Cho SJ (2003) Surgical treatment for pectus excavatum. J Korean Med Sci 18(3):360–364CrossRefPubMedPubMedCentralGoogle Scholar
  12. Johnson WR, Fedor D, Singhal S (2014) Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. J Cardiothorac Surg 9:25CrossRefPubMedPubMedCentralGoogle Scholar
  13. Kelly RE Jr, Mellins RB, Shamberger RC, Mitchell KK, Lawson ML, Oldham KT, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb GW, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Cooper D, Bagley T, Quinn A, Moskowitz AB, Paulson JF (2013) Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg 217(6):1080–1089CrossRefPubMedGoogle Scholar
  14. Kelly RE, Goretsky MJ, Obermeyer R, Kuhn MA, Redlinger R, Haney TS, Moskowitz A, Nuss D (2010) Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg 252(6):1072–1081CrossRefPubMedGoogle Scholar
  15. Lawson ML, Mellins RB, Paulson JF, Shamberger RC, Oldham K, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb GW, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Moskowitz AB, Hill J, Kelly RE Jr (2011) Increasing severity of pectus excavatum is associated with reduced pulmonary function. J Pediatr 159(2):256–261CrossRefPubMedGoogle Scholar
  16. Malek MH, Fonkalsrud EW, Cooper CB (2003) Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest 124(3):870–882CrossRefPubMedGoogle Scholar
  17. Nakagawa Y, Uemura S, Nakaoka T, Yano T, Tanaka N (2008) Evaluation of the Nuss procedure using pre- and postoperative computed tomographic index. J Pediatr Surg 43(3):518–521CrossRefPubMedGoogle Scholar
  18. Nuss D, Kelly RE Jr, Croitoru DP, Katz ME (1998) A 10-year review of minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 33(4):545–552CrossRefPubMedGoogle Scholar
  19. Nuss D, Croitoru DP, Kelly RE, Goretsky MJ, Nuss KJ, Gustin TS (2002) Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 12(4):230–234CrossRefPubMedGoogle Scholar
  20. Obermeyer RJ, Goretsky MJ (2012) Chest wall deformities in pediatric surgery. Surg Clin North Am 92(3):669–684CrossRefPubMedGoogle Scholar
  21. Park HJ, Lee SY, Lee CS (2004) Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg 39(3):391–395CrossRefPubMedGoogle Scholar
  22. Pawlak K, Gąsiorowski Ł, Gabryel P, Gałęcki B, Zieliński P, Dyszkiewicz W (2016) Early and late results of the Nuss procedure in surgical treatment of pectus excavatum in different age groups. Ann Thorac Surg 102(5):1711–1716CrossRefPubMedGoogle Scholar
  23. Rawitch MM (1949) The operative treatment of pectus excavatum. Ann Surg 129(4):429–444CrossRefGoogle Scholar
  24. Saxena AK, Schaarschmidt K, Schleef J, Morcate JJ, Willital GH (1999) Surgical correction of pectus excavatum: the Münster experience. Langenbeck’s Arch Surg 384(2):187–193CrossRefGoogle Scholar
  25. Schaarschmidt K, Kolberg-Schwerdt A, Dimitrov G, Straubeta J (2002) Submuscular bar, multiple pericostal bar fixation, bilateral thoracoscopy: a modified Nuss repair in adolescents. J Pediatr Surg 37(9):1276–1280CrossRefPubMedGoogle Scholar
  26. Umuroglu T, Bostancı K, Thomas DT, Yuksel M, Gogus FY (2013) Perioperative anesthetic and surgical complications of the Nuss procedure. J Cardiothorac Vasc Anesth 27(3):436–440CrossRefPubMedGoogle Scholar
  27. Wu PC, Knauer EM, McGowan GE, Hight DW (2016) Repair of pectus excavatum deformities in children: a new perspective of treatment using minimal access surgical technique. Arch Surg 136(4):419–424CrossRefGoogle Scholar
  28. Zhang DK, Tang JM, Ben XS, Xie L, Zhou HY, Ye X, Zhou ZH, Shi RQ, Xiao P, Chen G (2015) Surgical correction of 639 pectus excavatum cases via the Nuss procedure. J Thorac Dis 7(9):1595–1605PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG  2018

Authors and Affiliations

  • Piotr Cierpikowski
    • 1
  • Adam Rzechonek
    • 1
  • Piotr Błasiak
    • 1
  • Hanna Lisowska
    • 2
  • Grzegorz Pniewski
    • 2
  • Patric Le Pivert
    • 3
  1. 1.Department of Thoracic SurgeryWrocław Medical UniversityWroclawPoland
  2. 2.Department of Thoracic SurgeryLower Silesian Center for Lung DiseasesWroclawPoland
  3. 3.Interventional Drug Delivery Systems and Strategies GroupJupiterUSA

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