Multiple-bar Nuss operation: an individualized treatment scheme for patients with significantly asymmetric pectus excavatum

Ben, Xiao Song; Deng, Cheng; Tian, Dan; Tang, Ji Ming; Xie, Liang; Zhou, Zehua; Zhou, Hai Yu; Zhang, Dong Kun; Shi, Ruiqing; Qiao, Guibin; Chen, Gang

doi:10.21037/jtd.2019.12.43

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…8 While studies show that the multiple bar Nuss operation is safe and effective, there is limited data on how multiple bars affect rates of postoperative complications. 10 12 Cierpikowski et al described an overall increase in complications with the placement of multiple bars, although specific complications were not detailed. 13 With univariate analysis, our study identified a significant increase in odds of pleural effusion, postoperative thoracostomy tube placement, and readmission.…”

Section: Discussionmentioning

confidence: 99%

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

et al. 2021

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Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.

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Section: Discussionmentioning

confidence: 99%

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

et al. 2021

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“…Treatment for PE has changed in terms of surgical approaches, from the Ravitch procedure, to minimally invasive techniques, such as the Nuss procedure [ 3 , 6 , 7 ]. The Nuss operation, introduced by Donald Nuss [ 8 ], could be used to remodel chest wall deformities without cartilage resection and has been performed throughout the world with various advantages, including a less invasive nature and better outcomes [ 9 , 10 ]. However, the original Nuss procedure described a single-bar insertion, which might be insufficient for the proper correction of a heavy chest wall [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…introduced by Donald Nuss [8], could be used to remodel chest wall deformities without cartilage resection and has been performed throughout the world with various advantages, including a less invasive nature and better outcomes [9,10]. However, the original Nuss procedure described a single-bar insertion, which might be insufficient for the proper correction of a heavy chest wall [7].…”

Section: Plos Onementioning

confidence: 99%

The effectiveness of double-bar correction for pectus excavatum: A comparison between the parallel bar and cross-bar techniques

et al. 2020

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To compare the effectiveness between parallel bar and crossbar techniques for treating pectus excavatum. Methods A total of 80 patients who underwent parallel bar insertion (group 1) or crossbar insertion (group 2) were evaluated retrospectively. From the pre-and post-operative chest CT images, vertebral-level-specific pectus indices were defined as the ratio of the maximum transverse diameter to the anteroposterior diameter of the thoracic cavity at a specific vertebral level and measured at 3 levels up (3Up-PI, 2Up-PI, 1Up-PI) and 1 vertebral level down (1Down-PI) from the narrowest point. The effectiveness of double-bar correction was compared between the 2 groups using postoperative vertebral level-specific pectus index changes. Results A total of 44 patients were enrolled in group 1, and 36 patients were enrolled in group 2. Preoperative pectus index values were not different between the 2 groups (4.5 ± 1.0 vs. 4.9 ± 1.5, P = 0.135). After double-bar correction, pectus index significantly decreased in both groups. There were no differences in postoperative pectus indices between the 2 groups (2.7 ± 0.4 vs. 2.6 ± 0.3, P = 0.197). Postoperative changes in 3Up-PI, 2Up-PI, and 1Up-PI were not significantly different between the 2 groups (P > 0.05). However, postoperative changes at the narrowest level and at 1Down-PI were significantly greater in group 2 than in

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“…3 Modifications of the technique such as using a stabilizer and more bars at different levels of the chest have significantly reduced the complication rate. 4,5 PE often worsens at about the time a child starts puberty. However, the ideal age for elective repair of PE is still controversial.…”

Section: Introductionmentioning

confidence: 99%

“…3 Modifications of the technique such as using a stabilizer and more bars at different levels of the chest have significantly reduced the complication rate. 4,5…”

Section: Introductionmentioning

confidence: 99%

Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience

Chu,

Chang,

Yang

et al. 2024

Journal of the Chinese Medical Association

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Background: We aimed to assess the effectiveness of the Nuss procedure for pectus excavatum (PE) and explore the impacts of sex and age on outcomes. Methods: We retrospectively reviewed 594 consecutive children ≤ 18 years of age who underwent the thoracoscopy-assisted Nuss technique between January 2006 and July 2019. The severity of pectus deformity was calculated according to the Haller index (HI). The classification of PE and clinical data including complications were analyzed. Results: Of the 594 patients, 456 (76.8%) were boys and 138 (23.2%) were girls. The mean age at surgery was 10.0±5.0 years. The most common types of PE were 1A and 2A2 according to Park’s classification. Intraoperative and postoperative complication rates were 2/594 (0.3%) and 74/594 (12.5%), respectively. The most common complication was bar displacement. The bar was removed in 414 patients 3.5±0.8 years later. The mean preoperative HI, postoperative HI with bar, and HI after bar removal were 4.2±1.7, 2.4±0.3 and 2.7±0.5, respectively. Compared to the preoperative HI, both the postoperative HI with bar and HI after bar removal were significantly lower (p<0.001). For preschool-age children, the preoperative HI was significantly higher (p=0.027) and the change in HI significantly improved compared to school-age children (p=0.004). Boys and adolescents needed significantly more bars and stabilizers. Conclusion: Surgical correction of PE using the Nuss procedure is a safe procedure and improves the HI in children of different ages, even in those younger than 6 years of age.

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Multiple-bar Nuss operation: an individualized treatment scheme for patients with significantly asymmetric pectus excavatum

Cited by 11 publications

References 22 publications

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

The effectiveness of double-bar correction for pectus excavatum: A comparison between the parallel bar and cross-bar techniques

Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience

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