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Recent Modifications of the Nuss Procedure: The Pursuit of Safety During the Minimally Invasive Repair of Pectus Excavatum.

Authors :
Kelly Jr., Robert E.
Obermeyer, Robert J.
Goretsky, Michael J.
Kuhn, M. Ann
Frantz, Frazier W.
McGuire, Margaret M.
Duke, Duane S.
Daniel, Antarius
Nuss, Donald
Source :
Annals of Surgery; Feb2022, Vol. 275 Issue 2, pe496-e502, 7p
Publication Year :
2022

Abstract

Objective: To review standardized Nuss correction of pectus excavatum and vacuum bell treatment over the last 10 years. Summary of Background Data: In 2010, we reported 21 years of the Nuss procedure in 1215 patients. Methods: Over the last 10 years, 2008–2018, we evaluated 1885 pectus excavatum patients. Surgery was indicated for well-defined objective criteria. A consistent operation was performed by 8 surgeons in 1034 patients, median 15 years, (range 6–46); 996 were primary, and 38 redo operations. Surgical patients' mean computed tomography index was 5.46. Mitral valve prolapse was present in 5.4%, Marfan syndrome in 1.1% and scoliosis in 29%. Vacuum bell treatment was introduced for 218 patients who did not meet surgical criteria or were averse to surgery. Results: At primary operation, 1 bar was placed in 49.8%; 2 bars, 49.4%; and 3 bars, 0.7%. There were no deaths. Cardiac perforation occurred in 1 patient who had undergone previous cardiac surgery. Paraplegia after epidural catheter occurred once. Reoperation for bar displacement occurred in 1.8%, hemothorax in 0.3%, and wound infection in 2.9%; 1.4% required surgical drainage. Allergy to stainless steel was identified in 13.7%. A good anatomic outcome was always achieved at bar removal. Recurrence requiring reoperation occurred in 3 primary surgical patients. Two patients developed carinate overcorrection requiring reoperation. Vacuum bell treatment produced better results in younger and less severe cases. Conclusions: A standardized Nuss procedure was performed by multiple surgeons in 1034 patients with good overall safety and results in primary repairs. Vacuum bell treatment is useful. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00034932
Volume :
275
Issue :
2
Database :
Supplemental Index
Journal :
Annals of Surgery
Publication Type :
Academic Journal
Accession number :
154580385
Full Text :
https://doi.org/10.1097/SLA.0000000000003877