Results of Nuss procedures for the correction of pectus excavatum

The principle of the Nuss procedure is remodulation of the chest using a steel bar inserted by means of two small skin incisions along the axillary lines.

The assessment of the outcome after treatment.

Between July 1998 and March 2003 66 children were operated on by Nuss technique to correct pectus excavatum in our department. Age ranged from 1 to 19 years (mean 11.8 years). The evaluation prior to surgery included chest X-ray and CT, pulmonology consultation with pulmonary function tests and cardiology consultation. We used a modified technique in which we inserted the supporting bar directly from the right side, with no thoracoscope, no sharp tools and no guiding tape. Intrapleural or epidural bupivacaine was used for postoperative pain control.

Duration of the operation was between 20 and 60 min. Complications included wound infections in six children, haemothorax in three and pneumonia in one. In 56 children the early cosmetic results were very good. In 5 children the excavation of the lower part of the sternum has persisted, in 5 children the excavation of the sternum was corrected but asymmetric thickening in the parasternal region persisted. In all cases the results were satisfactory for both the children and their parents. In 24 children the supporting bar was removed two years after the first operation. Postoperative courses were uneventful and the cosmetic results were good. In one child we observed a recurrence of the deformity six months after bar removal.

The early results of the new operation for pectus excavatum are good in most children. The minimal invasiveness of this method suggests that this procedure is indicated in cases where the defects are only cosmetic.