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


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.


pectus excavatum; Nuss procedure


Nuss D, Kelly R, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998 Apr;33(4):545-52. doi: 10.1016/S0022-3468(98)90314-1.

Croitoru DP, Kelly RE Jr, Goretsky MJ, Lawson ML, Swoveland B, Nuss D. Experience and modifica-tion update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg. 2002 Mar;37(3):437-45. doi: 10.1053/jpsu.2002.30851.

Hebra A. Minimally invasive pectus surgery. Chest Surg Clin N Am. 2000 May;10(2):329-39, vii.

Watanabe A, Watanabe T, Obama T, et al. The use of a lateral stabilizer increases the incidence of wound trouble following the Nuss procedure. Ann Thorac Surg. 2004 Jan;77(1):296-300. doi: 10.1016/S0003-4975(03)01335-3.

Molik KA, Engum SA, Rescorla FJ, West KW, Scherer LR, Grosfeld JL. Pectus excavatum repair: expe-rience with standard and minimal invasive techniques. J Pediatr Surg. 2001 Feb;36(2):324-8. doi: 10.1053/jpsu.2001.20707.

Schalamon J, Pokall S, Windhaber J, Hoellwarth ME. Minimally invasive correction of pectus excava-tum in adult patients. J Thorac Cardiovasc Surg. 2006 Sep;132(3):524-9. doi: 10.1016/j.jtcvs.2006.04.038.

Aronson DC, Bosgraaf RP, van der HC, Ekkelkamp S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World J Surg. 2007 Jan;31(1):26-9; discussion 30. doi: 10.1007/s00268-005-0779-1.

Kim DH, Hwang JJ, Lee MK, Lee DY, Paik HC. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg. 2005 Sep;80(3):1073-7. doi: 10.1016/j.athoracsur.2005.03.070.

Hebra A, Swoveland B, Egbert M, et al. Outcome analysis of minimally invasive repair of pectus exca-vatum: review of 251 cases. J Pediatr Surg. 2000 Feb;35(2):252-7; discussion 257-8. doi: 10.1016/S0022-3468(00)90019-8.

Park HJ, Lee SY, Lee CS, Youm W, Lee KR. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg. 2004 Jan;77(1):289-95. doi: 10.1016/S0003-4975(03)01330-4.

Ravitch MM. The operative treatment of pectus excavatum. Ann Surg. 1949 Apr;129(4):429-44. doi: 10.1016/S0022-3476(56)80075-9.

Iida H, Sudo Y, Yamada Y, Matsushita Y, Eda K, Inoue Y. Nonprosthetic surgical repair of pectus ex-cavatum. Ann Thorac Surg. 2006 Aug;82(2):451-6. doi: 10.1016/j.athoracsur.2006.03.052.

Davis JT, Weinstein S. Repair of the pectus deformity: results of the Ravitch approach in the current era. Ann Thorac Surg. 2004 Aug;78(2):421-6. doi: 10.1016/j.athoracsur.2004.03.011.

Fonkalsrud EW. Open repair of pectus excavatum with minimal cartilage resection. Ann Surg. 2004 Aug;240(2):231-5. doi: 10.1097/

Jaroszewski DE, Fonkalsrud EW. Repair of pectus chest deformities in 320 adult patients: 21 year ex-perience. Ann Thorac Surg. 2007 Aug;84(2):429-33. doi: 10.1016/j.athoracsur.2007.03.077.

Wang LS, Kuo KT, Wang HW, Yang CH, Chin T. A novel surgical correction through a small transverse incision for pectus excavatum. Ann Thorac Surg. 2005 Nov;80(5):1951-4. doi: 10.1016/j.athoracsur.2004.05.029.

Krasopoulos G, Dusmet M, Ladas G, Goldstraw P. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Eur J Cardiothorac Surg. 2006 Jan;29(1):1-5. doi: 10.1016/j.ejcts.2005.09.018.

Jacobsen EB, Thastum M, Jeppesen JH, et al. Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg. 2010 Mar;20(2):85-91. doi: 10.1055/s-0029-1243621.

Haecker FM. The vacuum bell for conservative treatment of pectus excavatum: the Basle experience. Pediatr Surg Int. 2011 Jun;27(6):623-7. doi: 10.1007/s00383-010-2843-7.

O'Keefe J, Byrne R, Montgomery M, Harder J, Roberts D, Sigalet DL. Longer term effects of closed re-pair of pectus excavatum on cardiopulmonary status. J Pediatr Surg. 2013 May;48(5):1049-54. doi: 10.1016/j.jpedsurg.2013.02.024.

Lesbo M, Tang M, Nielsen HH, et al. Compromised cardiac function in exercising teenagers with pectus excavatum. Interact Cardiovasc Thorac Surg. 2011 Oct;13(4):377-80. doi: 10.1510/icvts.2011.267054.

Gürkan U, Aydemir B, Aksoy S, et al. Echocardiographic assessment of right ventricular function be-fore and after surgery in patients with pectus excavatum and right ventricular compression. Thorac Cardiovasc Surg. 2014 Apr;62(3):231-5. doi: 10.1055/s-0033-1342941.

Copyright (c) 2020 Ia.V. Fishchenko, A.V. Shevchuk, A.І. Saponenko, N.E. Yeremik

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