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Minimal-Invasive Repair of Pectus Excavatum

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Minimally Invasive Thoracic and Cardiac Surgery

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Abstract

Since the end of the 1990s, the management of pectus excavatum has undergone major changes. Observations about the correction of skeletal abnormalities in orthopedic surgery and the possible chest remodeling in emphysema patients aided in the development of a minimal-invasive surgical procedure for pectus excavatum by Donald Nuss. The basis of this “Nuss procedure” is the placement of a convex stainless steel bar under the sternum through two small lateral thoracic incisions. This bar position allows the anterior displacement of sternum and ribs without need for bone or cartilage resection. Various studies show excellent outcomes after the minimal-invasive repair of pectus excavatum.

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References

  1. Al-Assiri A, Kravarusic D, Wong V et al (2009) Operative innovation to the “Nuss” procedure for pectus excavatum: operative and functional effects. J Pediatr Surg 44:888–892

    Article  PubMed  Google Scholar 

  2. Backer OG, Brunner S, Larsen V (1961) The surgical treatment of funnel chest. Initial and follow-up results. Acta Chir Scand 1961(121):253–261

    Google Scholar 

  3. Brigato RR, Campos JRM, Jatene FB et al (2008) Pectus excavatum: evaluation of Nuss technique by objective methods. Interact Cardiovasc Thorac Surg 7:1084–1088

    Article  PubMed  Google Scholar 

  4. Cahill JL, Lees GM, Thomas RH (1984) A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair. J Pediatr Surg 19:430–433

    Article  PubMed  CAS  Google Scholar 

  5. Cartoski MJ, Nuss D, Goretsky MJ et al (2006) Classification of the dysmorphology of pectus excavatum. J Pediatr Surg 41:1573–1581

    Article  PubMed  Google Scholar 

  6. Chang PY, Chang CH, Lai JY et al (2009) Analysis of changes to the anterior chest wall after the Nuss procedure-an objective measurement of pectus excavatum. J Pediatr Surg 44:2291–2295

    Article  PubMed  Google Scholar 

  7. Chang PY, Hsu ZY, Lai JY et al (2010) Increase in intrathoracic volume in pectus excavatum patients after the Nuss procedure. Med Biol Eng Comput 48:133–137

    Article  PubMed  Google Scholar 

  8. Chung CS, Myrianthopoulus NC (1975) Factors affecting risks of congenital malformations. I. Analysis of epidemiologic factors in congenital malformations. Report from the collaborative perinatal project. Birth Defects Orig Artic Ser 11:1–22

    PubMed  CAS  Google Scholar 

  9. Creswick HA, Stacey MW, Kelly J et al (2006) Family study of the inheritance of pectus excavatum. J Pediatr Surg 41:1699–1703

    Article  PubMed  Google Scholar 

  10. Daunt S, Cohen J, Miller S (2004) Age-related normal ranges for the Haller index in children. Pediatr Radiol 34:326–330

    Article  PubMed  Google Scholar 

  11. Derveaux L, Clarysse I, Ivanoff I et al (1989) Preoperative and postoperative abnormalities in chest x-ray indices and in lung function in pectus deformities. Chest 95:850–856

    Article  PubMed  CAS  Google Scholar 

  12. Ebstein E (1901) Über die angeborene und die erworbene Trichterbrust. In: Sammlung klinischer Vorträge 1–42. Breitkopf und Härtel, Leipzig, pp 541–542

    Google Scholar 

  13. Einsiedel E, Clausner A (1999) Funnel chest. Psychological and psychosomatic aspects in children, youngsters, and young adults. J Cardiovasc Surg 40:733–736

    CAS  Google Scholar 

  14. Feng J, Hu T, Liu W et al (2001) The biomechanical, morphologic, and histochemical properties of the costal cartilages in children with pectus excavatum. J Pediatr Surg 36:1770–1776

    Article  PubMed  CAS  Google Scholar 

  15. Fonkalsrud EW (2004) Management of pectus chest deformities in female patients. Am J Surg 187:192–197

    Article  PubMed  Google Scholar 

  16. Frick SL (2000) Scoliosis in children with anterior chest wall deformities. Chest Surg Clin N Am 10:427–436

    PubMed  CAS  Google Scholar 

  17. Fox ME, Bensard DD, Roaten JB et al (2005) Positioning for the Nuss procedure: avoiding brachial plexus injury. Paediatr Anaesth 15:1067–1071

    PubMed  Google Scholar 

  18. Gips H, Zaitsev K, Hiss J (2009) Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature. Pediatr Surg Int 24:617–620

    Article  Google Scholar 

  19. Haecker FM, Berberich T, Mayr J et al (2009) Near-fatal bleeding after transmyocardial ventricle lesion during removal of the pectus bar after the Nuss procedure. J Thorac Cardiovasc Surg 138:1240–1241

    Article  PubMed  Google Scholar 

  20. Haller JA (2000) History of the operative management of pectus deformities. Chest Surg Clin N Am 10:227–235

    PubMed  Google Scholar 

  21. Haller JA Jr, Shermate DW, Tepas JJ et al (1978) Correction of pectus excavatum without prostheses or splints: objective measurement of severity and management of asymmetrical deformities. Ann Thorac Surg 26:73–79

    Article  PubMed  Google Scholar 

  22. Haller JA Jr, Kramer SS, Lietman SA (1987) Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg 22:904–906

    Article  PubMed  Google Scholar 

  23. Han Y, Wang J, Li W et al (2010) Non-thoracoscopic extrapleural Nuss procedure for the correction of pectus excavatum in children. Eur J Cardiothorac Surg 37:312–315

    PubMed  Google Scholar 

  24. Hebra A (2009) Minimally invasive repair of pectus excavatum. Semin Thorac Cardiovasc Surg 21:76–84

    Article  PubMed  Google Scholar 

  25. Hebra A, Swoveland B, Egbert M et al (2000) Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg 35:252–258

    Article  PubMed  CAS  Google Scholar 

  26. Hebra A, Gauderer MWL, Tagge EP et al (2001) A simple technique for preventing bar displacement with the Nuss repair of pectus excavatum. J Pediatr Surg 36:1266–1268

    Article  PubMed  CAS  Google Scholar 

  27. Hosie S, Sitkiewicz T, Petersen C et al (2001) Minimally invasive repair of pectus excavatum-the Nuss procedure. A European multicentre experience. Eur J Pediatr Surg 12:235–308

    Article  Google Scholar 

  28. Hümmer HP, Willital GH (1984) Morphologic findings of chest deformities in children corresponding to the Willital-Hümmer classification. J Pediatr Surg 19:562–566

    Article  PubMed  Google Scholar 

  29. Jacobsen EB, Thastum M, Jeppesen JH et al (2010) Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg 20:85–91

    Article  PubMed  Google Scholar 

  30. Johnson JN, Hartman TK, Pianosi PT et al (2008) Cardiorespiratory function after operation for pectus excavatum. J Pediatr 153:359–364

    Article  PubMed  Google Scholar 

  31. Krasopoulos G, Goldstraw P (2011) Minimally invasive repair of pectus excavatum deformity. Eur J Cardiothorac Surg 39:149–158

    Article  PubMed  Google Scholar 

  32. Krasopoulos G, Dusmet M, Ladas G et al (2006) Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Eur J Cardiothorac Surg 29:1–5

    Article  PubMed  Google Scholar 

  33. Kelly RE Jr (2008) Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg 17:181–193

    Article  PubMed  Google Scholar 

  34. Kelly RE Jr, Shamberger RC, Mellins RB et al (2007) Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg 205:205–216

    Article  PubMed  Google Scholar 

  35. Kim HK, Choi YH, Cho YH et al (2007) A comparative study of pericostal and submuscular bar fixation technique in the Nuss procedure. J Korean Med Sci 22:254–257

    Article  PubMed  Google Scholar 

  36. Lai JY, Wang CJ, Chang PY (2009) The measurement and designation of the pectus bar by computed tomography. J Pediatr Surg 44:2287–2290

    Article  PubMed  Google Scholar 

  37. Lawson ML, Cash TF, Akers R et al (2003) A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J Pediatr Surg 38:916–918

    Article  PubMed  Google Scholar 

  38. Malek MH, Berger DE, Housh TJ et al (2006) Cardiovascular function following surgical repair of pectus excavatum. Chest 130:506–516

    Article  PubMed  Google Scholar 

  39. Malek MH, Berger DE, Marelich WD et al (2006) Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg 30:637–643

    Article  PubMed  Google Scholar 

  40. Metzelder ML, Kuebler JF, Leonhardt J et al (2007) Self and parental assessment after minimally invasive repair of pectus excavatum: lasting satisfaction after bar removal. Ann Thorac Surg 83:1844–1849

    Article  PubMed  Google Scholar 

  41. Moss RL, Albanese CT, Reynolds M (2001) Major complications after minimally invasive repair of pectus excavatum: case reports. J Pediatr Surg 36:155–158

    Article  PubMed  CAS  Google Scholar 

  42. Nagasao T, Miyamoto J, Tamaki T et al (2007) Stress distribution on the thorax after the Nuss procedure for pectus excavatum results in different patterns between adult and child patients. J Thorac Cardiovasc Surg 134:1502–1507

    Article  PubMed  Google Scholar 

  43. Nakaoka T, Uemura S, Yano T et al (2009) Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients. J Pediatr Surg 44:1333–1336

    Article  PubMed  Google Scholar 

  44. Nakaoka T, Uemura S, Yoshida T et al (2010) Overgrowth of costal cartilage is not the etiology of pectus excavatum. J Pediatr Surg 45:2015–2018

    Article  PubMed  Google Scholar 

  45. Nuss D (2008) Minimally invasive surgical repair of pectus excavatum. Semin Pediatr Surg 17:209–217

    Article  PubMed  Google Scholar 

  46. Nuss D, Kelly RE Jr, Croitoru DP et al (1998) A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 33:545–552

    Article  PubMed  CAS  Google Scholar 

  47. Nuss D, Croitoru DP, Kelly RE et al (2002) Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 12:230–234

    Article  PubMed  CAS  Google Scholar 

  48. Nuss D, Croitoru DP, Kelly RE Jr (2005) Congenital chest wall deformities. In: Ashcraft KW, Holocomb GW, Murphy JP (eds) Pediatric surgery, 4th edn. Elsevier, Philadelphia

    Google Scholar 

  49. Ohno K, Nakamura T, Azuma T et al (2009) Modification of the Nuss procedure for pectus excavatum to prevent cardiac perforation. J Pediatr Surg 44:2426–2430

    Article  PubMed  Google Scholar 

  50. Peterson RJ, Young WG Jr, Godwin JD et al (1985) Noninvasive assessment of exercise cardiac function before and after pectus excavatum repair. J Thorac Cardiovasc Surg 90:251–260

    PubMed  CAS  Google Scholar 

  51. Pilegaard HK, Licht PB (2008) Early results following the Nuss operation for pectus excavatum – a single-institution experience of 383 patients. Interact Cardiovasc Thorac Surg 7:54–57

    Article  PubMed  Google Scholar 

  52. Pilegaard HK, Licht PB (2009) Can absorbable stabilizers be used routinely in the Nuss procedure? Eur J Cardiothorac Surg 35:561–564

    Article  PubMed  Google Scholar 

  53. Pyeritz RE, McKusick VA (1979) The Marfan syndrome: diagnosis and management. N Engl J Med 300:772–777

    Article  PubMed  CAS  Google Scholar 

  54. Quigley PM, Haller J, Jelus KL et al (1996) Cardiorespiratory function before and after corrective surgery in pectus excavatum. J Pediatr 128:638–643

    Article  PubMed  CAS  Google Scholar 

  55. Ravitch MM (1949) The operative treatment of pectus excavatum. Ann Surg 129:429–444

    Article  PubMed  CAS  Google Scholar 

  56. Ravitch MM (1997) Congenital deformities of the chest wall and their operative correction. W.B. Saunders Company, Philadelphia

    Google Scholar 

  57. Rebeis EB, Campos JR, Fernandez A et al (2007) Anthropometric index for Pectus excavatum. Clinics 62:599–606

    Article  PubMed  Google Scholar 

  58. Schaarschmidt K, Kolberg-Schwerdt A, Dimitrov G et al (2002) Submuscular bar, multiple pericostal bar fixation, bilateral thoracoscopy: a modified nuss repair in adolescents. J Pediatr Surg 37:1276–1280

    Article  PubMed  Google Scholar 

  59. Serafin J, Swiatkowski J, Majkusiak RNP (2003) 40-Year experience in surgical treatment of congenital chest deformations – ethiopathogenesis, operative techniques and clinical results. Acta Chir Orthop Traumatol Cech 70:207–213

    PubMed  CAS  Google Scholar 

  60. Shamberger RC, Welch KJ (1988) Surgical repair of pectus excavatum. J Pediatr Surg 23:615–622

    Article  PubMed  CAS  Google Scholar 

  61. Shin S, Goretsky MJ, Kelly J et al (2007) Infectious complications after the Nuss repair in a series of 863 patients. J Pediatr Surg 42:87–92

    Article  PubMed  Google Scholar 

  62. St Peter SD, Sharp RJ, Upadhyaya P (2007) A straightforward technique for removal of the substernal bar after the Nuss operation. J Pediatr Surg 42:1789–1791

    Article  PubMed  Google Scholar 

  63. Sweet RH (1944) Pectus excavatum: report of two cases successfully operated upon. Ann Surg 119:922–934

    Article  PubMed  CAS  Google Scholar 

  64. Tsirikos AI, McMaster MJ (2005) Congenital anomalies of the ribs and chest wall associated with congenital deformities of the spine. J Bone Joint Surg Am 87:2523–2536

    Article  PubMed  Google Scholar 

  65. Weg JG, Krumholz RA, Harkleroad LE (1967) Pulmonary dysfunction in pectus excavatum. Am Rev Respir Dis 96:936–945

    PubMed  CAS  Google Scholar 

  66. Welch KJ (1958) Satisfactory surgical correction of pectus excavatum deformity in childhood; a limited opportunity. J Thorac Surg 36:697–713

    PubMed  CAS  Google Scholar 

  67. Zeng Q, Lai JY, Wang XM et al (2008) Costochondral changes in the chest wall after the Nuss procedure: ultrasonographic findings. J Pediatr Surg 43:2147–2150

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Thoracic Surgery, Inselspital Berne, Berne, Switzerland

    Beatrix Hoksch M.D.

  2. Division of Thoracic Surgery, Department of General Surgery, Atrium Medical Centre, Henri Dunantstraat 5, Heerlen, 6401 CX, The Netherlands

    Jan Siebenga M.D.

  3. Division of General Thoracic Surgery, University Hospital Berne, Freiburgstrasse, Berne, 3010, Switzerland

    Ralph Alexander Schmid M.D.

Authors
  1. Beatrix Hoksch M.D.
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  2. Jan Siebenga M.D.
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  3. Ralph Alexander Schmid M.D.
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Correspondence to Jan Siebenga M.D. .

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Editors and Affiliations

  1. Klinik Hirslanden, Thoraxzentrum Zürich, Witellikerstr. 40, Zürich, 8008, Switzerland

    Rolf Gilbert Carl Inderbitzi

  2. , Division of General Thoracic Surgery, University Hospital Berne
, Freiburgstr. 2010, Berne, 3010, Switzerland

    Ralph Alexander Schmid

  3. , Department of Cardio-Thoracic Surgery, University of Pisa, Via Paradisa 2, Pisa, 56100, Italy

    Franca M. A. Melfi

  4. St. Mary's Hospital, Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Praed Street, LONDON, W2 1NY, United Kingdom

    Roberto Pasquale Casula

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Hoksch, B., Siebenga, J., Schmid, R.A. (2012). Minimal-Invasive Repair of Pectus Excavatum. In: Inderbitzi, R., Schmid, R., Melfi, F., Casula, R. (eds) Minimally Invasive Thoracic and Cardiac Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11861-6_31

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  • DOI: https://doi.org/10.1007/978-3-642-11861-6_31

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