Treatment of pectus excavatum in patients over 20 years of age

The ideal time to operate on pectus excavatum (PE) using the Nuss procedure (NP) is between 12 and 18 years of age, because it is more difficult to bend the sternum of older patients and they have more pain and complications. The authors present a prospective study of adult patients with PE operated on by NP, analyzing technical improvements, new tricks, bar modifications, and preliminary outcomes.

From May 2003 to September 2009, 19 patients presenting PE (group 1), aged 20-27 years, underwent NP. A modified operation was performed in 10 patients using the scope at the axilla; the bar needed hyperconvex modeling in the middle and extended internal curving of its extremities before rotation at the thorax. A new and more resistant bar was designed and was used in the last 5 patients. Two stabilizers were implanted in 11 cases. Group 1 patients were compared with a group of 26 teenagers operated on before 20 years of age (group 2) during the same period.

All operations could be performed despite the more intense rigidity of the anterior thoracic wall in group 1. It was easier in the last patients who received thicker bars. After the third postoperative day, the operations were more painful in group 1, requiring more potent analgesic drugs. However, the adults were more tolerant and complained less than most patients of group 2. There were no differences between the two groups in operative times, complications, or hospitalization.

Patients with PE can be operated on during the third decade of life by the NP, facilitated by compensating bending of the bar, a stronger bar, and the use of potent analgesics, leading to outcomes similar to those in younger patients.