DOI: https://doi.org/10.22141/2224-1507.9.2.2019.172124

Our experience of using Nuss thoracoplasty as a method of correction of pectus excavatum

Ia.V. Fishchenko, A.V. Shevchuk, A.І. Saponenko, N.E. Yeremik

Abstract


Background. Pectus excavatum is a defect in the deve­lopment of the chest, often a manifestation of dyshistogenetic syndromes. In 1998, Nuss and colleagues reported on a new method for minimally invasive correction of pectus excavatum. The undoubted advantages of the Nuss procedure are minimal invasiveness and maximum cosmetic effect. However, many authors point to a rather high incidence of complications when using this technique. The purpose was to evaluate the results of surgical treatment of pectus excavatum using Nuss procedure. Material and me­thods. The study involved 97 patients with pectus excavatum, who underwent minimally invasive correction according to the Nuss method. The study was conducted in the spinal surgery clinic of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” from 2015 to 2018. Results. In 83 (85.5 %) patients, we managed to achieve the perfect cosmetic result. In 88 (90.7 %) persons, we used one fixation device, in 6 (6.1 %) patients — 2, in 3 (3.2 %) — 3 fixation devices. The following complications were detected: in 10 (10.3 %) cases — pneumothorax, in 2 (2.06 %) — hemothorax followed by pleural puncture, pneumonia was diagnosed in 2 (2.06 %) patients, pleural effusion — in 2 (2.06 %), empyema — in 1 (1.03 %), seroma — in 1 (1.03 %), deep infection — in 1 (1.03 %). One patient (1.03 %) underwent repeated operation due to the dislocation of the fixation device. At present, fixation devices were removed in 46 patients (47.4 %), the final results of these patients were considered to be good directly during discharge and at follow-up after 1 month. Conclusions. Nuss procedure is the least traumatic surgery for the correction of pectus excavatum and is applicable in children from an early age. In turn, we consider 13–16 years as the optimal age for the operation. The rationale for this is that changes in the heart and lungs at this age are reversible, and the fixation devices are in the body until the end of child’s growth, which reduces the risk of recurrence of the deformity to virtually zero.


Keywords


pectus excavatum; Nuss procedure

References


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