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Pectus Excavatum: benefits of the mini invasive treatment (Nuss procedure) in children and adolescents

L. Mefat, F. Lavrand, F. Becmeur, A. Schneider, P. Vergnes

Departments of Pediatric Surgery from Bordeaux and Strasbourg, France



Introduction: In 1998, Donald Nuss proposed a mini invasive treatment for pectus excavatum without resection of the osteochondral cartilage. In this new technique we introduce, by thoracoscopy, a metal bar that elevates the sternum and allows the complete or almost complete correction of the deformation. Our study presents the results obtained with the Nuss technique, by thoracoscopy since 2004 in the Departments of Pediatric Surgery from Bordeaux and Strasbourg.

Materiel and methods: From 2004 to 2009, 37 patients with pectum excavatum were operated by thoracoscopy using the Nuss technique. The peroperative imaging included a thoracic tomodensitometry, with calculation of the cardio-thoracic index of Haller, patients underwent RFT and cardiologic examination with cardiac ultrasonography.

Results: All the patients presented aesthetic complaints and a major deformation of the thorax. 50% of the patients had respiratory dysfunction because of their deformation (abnormal RFT with restrictive syndrome). There weren’t any peroperative complications. 2 patients presented postoperative infectious complications that required ablation of the metal bar in one case. The hospital stay was from 4 to 12 days, with an average of 6 days. All the patients who have a metal bar are satisfied with the result and present a complete or almost complete correction of their deformation. After the metal bar ablation, the correction of pectus is maintained with satisfactory aesthetic results.

Discussions and conclusions: The Nuss technique utilized for the pectus excavatum is a mini invasive procedure adapted for children and adolescents that gives excellent aesthetic and functional results. The first possible complication remains the infection. The correction stability in time has to be evaluated.


Key words: pectus excavatum, mini invasive, Nuss procedure