[Correction of recurrent pectus excavatum post-Ravitch with the Nuss technique]

For one decade, the minimally invasive technique (MIRPE) of Nuss has been used in our Service as the elective technique for correction of Pectus Excavatum. If recurrences occur in patients that underwent open surgery, a new surgery of the same characteristics entails important technical problems, long surgical times and poor outcome. For this reason, we think that one specific indication for the MIRPE technique may be this type of patients.

Based on our experience with four patients with a recurrence of pectus excavatum after an open surgery "Ravitch type", we illustrate the fundamental aspects for the development of the Nuss technique, adapted to this type of patients. The factors to be consider are: Systematic bilateral thoracoscopy with a suitable position of the two towers to guarantee a good visualisation of the passage of the introducer clamp by the mediastino. Use of thoracoscope with work channel on the right side, that allows the releasing of adherences and with a 5 mm lens on the left side. Use of a large introducer clamp more length for adolescent patients, The rest of the material is the usual one in this protocol surgery. Our patients did not present any remarkable incidences, with very satisfactory results.

We found of great importance for the good development of the technique to establish a correct strategy prior to surgery and to dispose a good organisation of the surgery room. The surgery must be carried out in a spacious surgical room, given the great amount of material that is used. It is important to be familiarized with the procedure, because even if performed in a regulated way, variations in the positioning and fixation of the bar are frequently needed.