Peri-operative data on the nuss procedure in children with pectus excavatum: independent survey of the first 20 years' data

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Abstract

Introduction
The cardiothoracic surgeons are moving towards minimally invasive techniques. Such a technique is the Nuss repair (alias Minimally Invasive Repair of Pectus Excavatum or Miniature Access Pectus Excavatum Repair) for pectus excavatum (funnel chest) 1, the commonest chest wall anomaly in humans 2, first described in 1594 by Johannes Schenk, occurring in approximately 1 in every 400 births, males being afflicted 5 times more often than females. The indication for correction is primarily cosmetic, although the potential for cardiorespiratory improvement can be considered.

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The original Nuss technique has being previously described 1,24. Its principle is the permanent reduction of the bone deformity by insertion of one (or more) malleable metal bars in order to refashion the contour of the growing thorax.

Advantages and disadvantages of the Nuss in relation to open techniques (such as Ravitch 2 and Willital-Hegemann that include extensive thoracic incisions and multiple thoracic osteochondrectomies (resections of ribs and cartilage) are presented in Table 1.

The principal advantage over these techniques is avoidance of osteochondrotomies and thence allowance for normal growth of the thorax, as subperichondral resection of the costal cartilages may halt the growth of the thoracic cage in toddlers and adolescents.

The metalwork is later removed as a day-case operation (nor requiring overnight stay in hospital) under general anaesthesia.

The Nuss operation can be performed with or without use of thoracoscopy. The selection of age for the Nuss varies with clinical, personal and socio-economical reasons (such as change of school and fear of intimidation by new peers), while removal of bars is scheduled within two to three years from the insertion. In Britain, some surgeons prefer to perform Nuss around the age of 10, before the child changes schools and thence is exposed to new peers. Some other surgeons will perform Nuss earlier, deciding on parental preference and individual clinical circumstances.

Materials and methods
We searched the literature with a simple strategy:
 

  • PubMed search
  • Last Date performed: 31 December 2006
  • Search keyword ├óÔé¼´åİNuss™, language English, Humans, children
  • Cross-validation by hand search to identify case series and exclude isolated case reports.
  • Primary outcomes: Mortality, morbidity, individual complications
  • Secondary outcomes: Procedure time and hospital stay.
  • Descriptive and summary statistics were performed.
  • Denominators were related to actual data. Missing data were not defaulted.

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References
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