Modified Nuss Operation for Pectus Excavatum: Design for Decreasing Cardiopulmonary Complications

Huang, Pei-Ming; Wu, En‐Ting; Yt, Tseng; Kuo, Shuenn‐Wen; Lee, Gary

doi:10.1055/s-2005-865849

Cited by 20 publications

(10 citation statements)

References 9 publications

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“…In cases with an extreme pectus defect, bilateral thoracoscopy may be also helpful [22]. Another method described to improve the safety and efficacy of mediastinal dissection includes making an additional subxiphoid incision for additional elevation [3,4]. Furthermore, single or multiple submuscular or pericostal bar fixation has reduced, or in some series eliminated, bar dislocation [23,24].…”

Section: Discussionmentioning

confidence: 95%

“…During this procedure, the blunt retrosternal dissection required to pass the corrective bar across the mediastinum is a potentially hazardous maneuver. Different modifications to the original Nuss procedure have included the use of thoracoscopic guidance to avoid inadvertent blind injury to thoracic structures, as well as techniques for reinforcing bar fixation [2][3][4][5]. However, despite a minimally invasive approach, the Nuss procedure is still associated with significant postoperative pain [6,7].…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Operative innovation to the “Nuss” procedure for pectus excavatum: operative and functional effects

Alassiri

Kravarušić

Wong

et al. 2009

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 98%

Operative innovation to the “Nuss” procedure for pectus excavatum: operative and functional effects

Alassiri

Kravarušić

Wong

et al. 2009

Journal of Pediatric Surgery

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“…This modification has helped to overcome the problems of broken wires and did not result in any bar flipping. Huang and coworkers [22] suggested using an AO plate with multiple holes instead of the original pectus bar, and steel wire fixation without the use of lateral stabilizers. Park et al [13] described a five-point fixation with wires around the ribs.…”

Section: Discussionmentioning

confidence: 99%

Early complications of the Nuss procedure for pectus excavatum: a prospective study

et al. 2008

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The Nuss procedure is a minimally invasive method for the correction of pectus excavatum, with several centers reporting its successful application. Complications related to the Nuss procedure are not uncommon and life-threatening complications have been reported. This study focuses on the incidence and management of complications in a series of 167 children and adults with funnel chest corrected by Nuss procedure. Guidelines and strategies to avoid the most common and typical complications are proposed. All patients with funnel chest, operated between April 2000 and 2006 were evaluated prospectively. Our surgical approach involved the submuscular insertion of the pectus bar under right-sided thoracoscopic control. The bar was secured in most cases with one stabilizer on the right side on the underlying rib to prevent bar displacement. Postoperative pain was primarily managed by epidural catheters. All data in the patient report forms was prospectively entered in a database. All complications were documented and classified into major or minor complication. A major complication was noted, if an organ injury occurred or if a significant surgical intervention became necessary. A minor complication was documented, if either an endoscopy or an evacuation of fluid or gas from the thorax by puncture were necessary. One hundred and sixty seven patients (136 males and 31 females) with a mean age of 16.3 (range 5-40 years) were included in this study. Major complications occurred in seven patients (4.2%) and consisted of one intraoperative heart perforation, one piercing of the liver with the trocar, bar infections (n = 2) and significant bar displacement (n = 3). Minor complications were seen in 122 patients (73.1%) and consisted of breakage of wires used to secure the lateral stabilizer plate (n = 48), pleural effusions (n = 28), intraoperative rupture of the intercostal muscle (n = 15), pericardial tears without clinical significance (n = 7) and lung atelectasia (n = 4). Major complications related to the Nuss procedure were rare but preventable and could mainly be attributed to the learning curve. Most minor complications can be avoided by changing the technique, e.g. fixation of the bar and the stabilizer onto the underlying rib, use of PDS cords instead of metal wires to fix the bar and the stabilizer, entrance into and exit of the thorax medial to the rim of the pectus excavatum, etc. Some complications are related to the technique, such as minor pleural effusion or remaining gas in the thorax. Clear guidelines in regard to the technique are presented to prevent the majority of complications and thereby shorten the learning curve.

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“…Some precautions to ensure safety during the procedure have been mentioned in the literature [4]. Huang et al [11] reported that a subxiphoid skin incision was made to guide a bar and to decrease cardiopulmonary complications. In their modification, however, the subxiphoid operative scar could spoil cosmetic result.…”

Section: Discussionmentioning

confidence: 99%

Modification of the Nuss procedure for pectus excavatum to prevent cardiac perforation

Ohno

Nakamura

Azuma

et al. 2009

Journal of Pediatric Surgery

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Modified Nuss Operation for Pectus Excavatum: Design for Decreasing Cardiopulmonary Complications

Abstract: A small subxiphoid incision makes bar implantation easier and has reduced the incidence of major complications in this early experience with 15 patients.

Cited by 20 publications

References 9 publications

Operative innovation to the “Nuss” procedure for pectus excavatum: operative and functional effects

Operative innovation to the “Nuss” procedure for pectus excavatum: operative and functional effects

Early complications of the Nuss procedure for pectus excavatum: a prospective study

Modification of the Nuss procedure for pectus excavatum to prevent cardiac perforation

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