Lung function after the minimal invasive pectus excavatum repair (Nuss procedure)

Area of Science:

• Thoracic Surgery
• Pediatric Surgery
• Pulmonary Medicine

Background:

• The Nuss procedure, a minimally invasive surgery for pectus excavatum, was introduced in 1999, primarily for cosmetic reasons.
• Limited data exists on the Nuss procedure's impact on patients' lung function.

Purpose of the Study:

• To prospectively analyze the effect of the Nuss procedure on static and dynamic lung function variables.
• To evaluate changes in lung function at multiple time points: pre-operation, post-bar insertion, pre-bar removal, and post-bar removal.

Main Methods:

• Prospective analysis of 145 pediatric patients (104 male, 41 female) undergoing the Nuss procedure for pectus excavatum.
• Static lung function (total lung capacity, functional residual capacity, vital capacity) and dynamic lung function (forced expired volume in 1 s, maximum expiratory flow at 50% of vital capacity) were measured via spirometry and body box.
• Measurements were taken pre-operation, 6 months post-procedure, pre-bar removal, and 6 months post-removal, with results compared to normal values and analyzed using paired-samples t-tests (p=0.05).

Main Results:

• Six months after Nuss bar insertion, significant increases were observed in total lung capacity, functional residual capacity, vital capacity, forced expired volume in 1 s, and maximum expiratory flow.
• Prior to bar removal, functional residual capacity and maximum expiratory flow remained significantly increased.
• Six months after bar removal, no significant changes in any lung function variables were detected compared to preoperative values.

Conclusions:

• The Nuss procedure for pectus excavatum does not lead to improvements in pulmonary function.
• The procedure, performed for largely cosmetic reasons, does not negatively impact a patient's lung function.
• Long-term pulmonary function remains unchanged after the Nuss procedure and subsequent bar removal.