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Nuss Procedure: Pediatric Surgical Solution for Adults with Pectus Excavatum

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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.

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References

  1. Ravitch MM. The operative repair of pectus excavatum. Ann Surg 1949;129:429–444

    Article  CAS  PubMed  Google Scholar 

  2. Nuss D, Kelly RE, Croitoru DP, et al. A 10 years review of a minimally invasive technique for correction of pectus excavatum. J Pediatr Surg 1998;33:545–552

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  4. Hosie S, Sitkiewicz T, Petersen C, et al. Minimally invasive repair of pectus excavatum: the Nuss procedure. a European multicentre experience. Eur J Pediatr Surg 2002;12:235–238

    Article  PubMed  CAS  Google Scholar 

  5. Park HJ, Lee SY, Lee CS, et al. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg 2004;39:391–395

    Article  PubMed  Google Scholar 

  6. Croitoru DP, Kelly RE Jr, Goretsky MJ, et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg 2002;37:437–445

    Article  PubMed  Google Scholar 

  7. Nuss D. Recent experiences with minimally invasive pectus excavatum repair: “Nuss procedure.” Jpn J Thorac Cardiovasc Surg 2005;53:338–344

    Article  PubMed  Google Scholar 

  8. Nuss D, Croitoru DP, Kelly RE Jr, et al. Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 2002;2:230–234

    Article  Google Scholar 

  9. Coln D, Gunning T, Ramsay M, et al. Early experience with the Nuss minimally invasive correction of pectus excavatum in adults. World J Surg 2002; 26:1217–1221

    Article  PubMed  Google Scholar 

  10. Kim DH, Hwang JJ, Lee MK, et al. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg 2005;80:1073–1077

    Article  Google Scholar 

  11. Fonkalsrud EW, Reemtsen B. Force required to elevate the sternum of pecus excavatum patients. J Am Coll Surg 2002;195:575–577

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC, Academic Medical Center, PO Box 22700, 1100, DE, Amsterdam, The Netherlands

    Daniel C. Aronson MD, PhD, Remko P. Bosgraaf & Seine Ekkelkamp MD

  2. Vrije Universiteit Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands

    Daniel C. Aronson MD, PhD & Seine Ekkelkamp MD

  3. Department of Plastic and Reconstructive Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands

    Chantal van der Horst MD, PhD

Authors
  1. Daniel C. Aronson MD, PhD
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  2. Remko P. Bosgraaf
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  3. Chantal van der Horst MD, PhD
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  4. Seine Ekkelkamp MD
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Corresponding author

Correspondence to Daniel C. Aronson MD, PhD.

Additional information

Some of these data were presented at the International Surgical Week, 41st World Congress of Surgery of ISS/SIC, Durban, South Africa

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Aronson, D.C., Bosgraaf, R.P., van der Horst, C. et al. Nuss Procedure: Pediatric Surgical Solution for Adults with Pectus Excavatum. World J. Surg. 31, 26–29 (2007). https://doi.org/10.1007/s00268-005-0779-1

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  • DOI: https://doi.org/10.1007/s00268-005-0779-1

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