A Modified Nuss Procedure for Late Adolescent and Adult Pectus Excavatum

BACKGROUND: Although the Nuss procedure has been widely adopted as a standard procedure in children with pectus excavatum, reports focusing on its use in adults are rare. We retrospectively reviewed postoperative results to evaluate the safety and efficacy of the Nuss procedure in late adolescents and adults with pectus excavatum. METHODS: Between 2004 and 2007, a total of 44 patients (M:F = 38:6) with a median age of 20 underwent the Nuss procedure. The pectus bar was inserted under thoracoscopic guidance and the depressed sternum was lifted by means of a crane device before rotating the bar. The bar was secured with steel wires laterally at three points. A compound bar and sometimes double bar insertion was performed. RESULTS: The median length of hospital stay was three days. Complications occurred in nine patients, including pneumothorax in five, bar rotation in two, wound infection in two, and pericardial effusion in one. Reoperation was performed in three patients to correct bar rotation (n = 2) and incomplete repair (n = 1). Three of the 26 patients with a single bar required reoperation, whereas none of the 18 with a double bar had a second operation. There was no recurrence of the chest deformity over median follow-up of 12 months, except in one patient from whom the bar was removed prematurely. CONCLUSIONS: Using the thoracoscope, the compound bar technique, the 3-point wire fixation, the crane technique, and sometimes double bar insertion showed that the Nuss procedure could be performed safety and effectively in late adolescent and adult patients with pectus excavatum.