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Treatment of 452 Patients with Pectus Excavatum by Modified Nuss Technique

A. Razumovsky, A. Alkhasov, Z. Mitupov, D. Dallakyan, M. Savelyeva

Filatov Childrens’ Hospital, Moscow, Russia

 

Aim: To show the feasibility and effectiveness of modified Nuss technique for treatment of pectus excavatum.

Methods:  Since 2000 to 2016, 452 patients were treated by modified Nuss technique for pectus excavatum. The group of patients consisted of 334 males and 118 females, male to female ratio was 1:2,8. Ages ranged from 6 to 20 years. Mean Haller index was more than 3,3. 124 (27,4%) patients were syndromic.

Modified Nuss procedure main goals are retrosternal tunnel formation and bar passage in left to right direction, using self-designed instruments without thoracoscopic assistance, T-shaped titanium bar usage without stabilizers, bar fixation to the ribs.

Results: Mean operating time was 38±7.  Mean hospital stay was 6.5 days. Bar removed in 243 patients. Excellent cosmetic result achieved in 98% of patients. Residual deformity observed in 7 (1,9%). Bar remodeling for long term carrying done in 2 (0,4%). Prolonged epidural anesthesia used in all patients up to second postoperative day. Postoperative pneumothorax observed in 44 (9,8%), drain placed in 3 (0,6%). Hemothorax in 25 (5,5%), drain placement in 2 (0,4%). Bar displacement in 3 (0,6%). Overcorrection in 7 (1,6%). Simultaneous surgeries in 10 patients: 3 VATS patent ductud arteriousus ligation, 2 VATS lobectomy, 5 laparoscopic testicular vein ligation. Thoracoscopy done in 9 cases. 

Conclusion: Modified Nuss technique is a feasible method of surgical treatment for pectus excavatum, including patients with genetic disorders and combined forms of disease.  The technique is minimally invasive, safe enough to exclude the need of thoracoscopy in majority of cases. Decreases the risk of organ damage during the procedure, the bar displacement in postoperative period and allows to achieve excellent cosmetic results.

Keywords: pectus excavatum, modified Nuss procedure, Nuss procedure