Recent Modifications of the Nuss Procedure

Abstract

Objective: To review standardized Nuss correction of pectus excavatum and vacuum bell treatment over the last 10 years. Summary of Background Data: In 2010, we reported 21 years of the Nuss procedure in 1215 patients. Methods: Over the last 10 years, 2008-2018, we evaluated 1885 pectus excavatum patients. Surgery was indicated for well-defined objective criteria. A consistent operation was performed by 8 surgeons in 1034 patients, median 15 years, (range 6-46); 996 were primary, and 38 redo operations. Surgical patients' mean computed tomography index was 5.46. Mitral valve prolapse was present in 5.4%, Marfan syndrome in 1.1% and scoliosis in 29%. Vacuum bell treatment was introduced for 218 patients who did not meet surgical criteria or were averse to surgery. Results: At primary operation, 1 bar was placed in 49.8%; 2 bars, 49.4%; and 3 bars, 0.7%. There were no deaths. Cardiac perforation occurred in 1 patient who had undergone previous cardiac surgery. Paraplegia after epidural catheter occurred once. Reoperation for bar displacement occurred in 1.8%, hemothorax in 0.3%, and wound infection in 2.9%; 1.4% required surgical drainage. Allergy to stainless steel was identified in 13.7%. A good anatomic outcome was always achieved at bar removal. Recurrence requiring reoperation occurred in 3 primary surgical patients. Two patients developed carinate overcorrection requiring reoperation. Vacuum bell treatment produced better results in younger and less severe cases. Conclusions: A standardized Nuss procedure was performed by multiple surgeons in 1034 patients with good overall safety and results in primary repairs. Vacuum bell treatment is useful.

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

“…One of the most common modifications to the initially described Nuss procedure is the use of multiple bars as opposed to a single bar for correction of the defect. 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.…”

“…Studies have described the use of an SE as a widely accepted and common approach to increase visualization intraoperatively. 7,8 However, the effects of the SE on postoperative complications is not well described in the literature. Much of the current data regarding SE use is focused on intraoperative side effects, such as cardiac injury.…”

“…3,5,7 The benefits of certain techniques include improved visualization with the use of a SE and better cosmetic results with multiple bars. 8,9 Patient characteristics such as age, Haller index (HI), asymmetrical or long deformities, and comorbid connective tissue disease, in addition to surgeon experience and preference, guide intraoperative decision-making in placing multiple bars. 10 The Nuss procedure has become safer since its inception and provides excellent long-term results and patient satisfaction.…”

The management of pectus excavatum in pediatric patients: a narrative review

“…Kelly et al presented a large cohort of 1,215 MIRPE cases over 21 years, including interval modifications to the procedure, with an update released in 2022 ( 11 , 34 ). At the time of bar removal, good or excellent surgical outcomes were reported in 96% of patients.…”

Combined Ravitch and Nuss procedure for pectus excavatum with dyspnea following scoliosis repair

“…Therefore, surgeons must consider the risk of serious complications during surgical treatment of severe chest deformities. In several reports, scoliosis was identified in patients with PE [ 3 , 4 ], and surgical correction could be necessary for both PE and scoliosis repair. However, because a limited number of studies have reported patients who underwent surgery for PE and scoliosis, the treatment modality and surgical management for patients with both PE and scoliosis remain unclear.…”