Modified Nuss operation using introducer-bar complex for pectus excavatum in adults: a retrospective study

Abstract

Background Shortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue. Methods Patients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes. Results All patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30 ± 10.49 min, p < 0.001), and less blood loss during operation (6.25 ± 4.88 vs. 10.90 ± 5.75 ml, p = 0.003) than patients in the traditional procedure group. There was no significant difference in the length of incision, postoperative Haller index, cost, number of steel bars, postoperative surgical outcome and incidence of complications between the two groups. Conclusion Through the main clinical outcome were similar, our results shown that modified procedure may have the shorter operation time, postoperative hospital stay, and operation time for plate removal and less blood loss, which may bring potential clinical benefits to patients.

Complications and Outcomes of the Nuss Procedure in Adult Patients: A Systematic Review

“…The most common complications observed in adult patients were bar displacement, wound infection, pneumothorax, pleural effusion, reoperation, and chronic pain. Despite complications being more common with increased age, nine of 10 articles included in this review recommend the use of either a traditional or modified Nuss procedure to correct PE deformities in adult patients [ 8 - 11 , 13 - 17 ]. Kim et al reported significantly high rates of dissatisfaction in adult patients, mainly due to a higher incidence of preoperative asymmetrical deformity, which increased the risk of complications.…”

“…The exclusion criteria were the following: articles in a different language, case reports, articles detailing surgical techniques, review articles, articles in which patients underwent prior surgical intervention for PE, patient population less than 18 years old, patient population with less than or equal to 10 patients, articles with incomplete data, and non-human studies. We included articles in which the Nuss procedure was performed in adult patients over the age of 18 years and in which the outcomes and complications were discussed [8][9][10][11][12][13][14][15][16][17].…”

The Application of Complementary and Alternative Medicine in Polycystic Ovary Syndrome Infertility

“…Tai Chi is a traditional Chinese boxing. According to TCM, kidney deficiency is the fundamental pathogenesis of ovulation disorder infertility [135]. Tai Chi focuses on the function of "activating the waist," "waist is the house of the kidney," and the exercise of the waist helps the accumulation of the essence of the kidney [136].…”