[Complication and treatment for correction of pectus excavatum with Nuss procedure]

To review and investigate the complication and the treatment in Nuss procedure for correction of pectus excavatum.

From September 2005 to March 2009, 221 patients with pectus excavatum were treated with Nuss procedure, including 189 males and 32 females and aging 2 years old and 10 months to 25 years old (median 8 years and 7 months old). Of 18 patients with recurrent pectus excavatum, 12 patients underwent a Ravitch procedure and the recurrence time of the depression after the first operation was less than 1 year in 2 patients, 1-3 years in 3, 3-5 years in 5, and over 5 years in 2; 6 patients underwent a stemotumover operation and the recurrence time of the depression after the first operation was less than 1 year in 2 patients, 1-3 years in 1 and 3-5 years in 3. The other 203 patients had a primary Nuss procedure, and the course of disease was from 18 months to 24 years. The preoperative CT scan showed the Haller index was 4.36 +/- 1.34.

The operation in all the patients were performed successfully without complications of death, massive hemorrhage and intrathoracic organ injury. The time of operation was 25-80 minutes (mean 40 minutes). The bleeding volume during procedure was 5-25 mL, with an average of 10 mL. Local allergy occurred in 3 cases after 7-10 months of operation, wound reject reaction in 2 cases after 3 and 11 months respectively, and effusion in 3 cases after 6-10 months; incision healed after dressing change. Incision healed primarily in the other patients. Pneumothorax occurred in 3 cases when the operation finished and in 7 cases after 2-4 days, pleural effusion in 4 cases after 3-5 days of operation, Nuss plate displacement in 2 cases after 3 days and 9 months, respectively. The patients having complication recovered well after treatment. The complication rate was about 8.72% (17/195). The follow-up period was 2-37 months for 195 patients. The postoperative Haller index was 2.52 +/- 0.32 after 3 months of operation, showing statistically significant difference when compared with that before operation (P < 0.05).

Nuss procedure with non-thoracoscopic assistance for correction of pectus excavatum is safe because of less trauma and complication.