Is the grass greener? Early results of the Nuss Procedure

Background/Purpose: Minimal access surgery (MIS, Nuss Procedure) is gaining acceptance rapidly as the preferred method far pectus excavatum repair. Th is shift in operative management has followed a single institution's evalua tion of the procedure. This report describes an additional experience with the Nuss procedure. Methods:Twenty-one patients with pectus excavatum underwent repair by the N uss Procedure. The patients ranged in age from 5 to 15 years (average, 8.2 years). There were 19 boys and 2 girls. Results: In 1 patient (age 5 years) the MIS procedure was aborted because o f persistence of chest wall asymmetry. The other 20 patients had completion of their procedure without intraoperative complication. The operating time s ranged from 45 to 90 minutes; however, there was an additional anesthetic set-up time (average, 45 minutes). All cases utilized a single support bar (11 to 17 inches). Patients underwent extubation in the operating room and were admitted to a ward bed with an epidural catheter in place for pain co ntrol and received intravenous analgesia. The hospital stay ranged from 4 t o 11 days and averaged 4.9 days. Early postoperative complications included ileus (n = 1), bilateral pleural effusion (n = 2), atelectasis (n = 1), fu ngal dermatitis (n = 1), pneumothorax (n = 1), and flipped pectus bar (n = 2). Delayed complications included flipped pectus bar (n = 2), marked pectu s carinatum requiring bar removal (n = 1), mild carinatum (n = 1), mild bar deviation (n = 1), progressive chest wall asymmetry (n = 3) with 1 requiri ng bar removal and open pectus repair, pleural effusion (n = 1), and chroni c persistent pain requiring bar removal (n = 1). The length of follow-up is 3 to 20 months with an average of 12.3 months. Conclusions: The Nuss Procedure is quick, minimally invasive, and a technic ally easy method to learn; however, our data indicate there is a significan t learning curve. Although previous reports suggest that few complications occur, we believe further assessment of patient selection regarding age, pr esence of connective tissue disorder, and severe chest wall asymmetry are s till needed. Long-term follow-up also will be required to assure both healt h professionals and the public that this is the procedure of choice for pat ients with pectus excavatum. J Pediatr Surg 35:246-251. Copyright (C) 2000 by W.B. Saunders Company.