Surgical design and novel modified Nuss procedure for pectus excavatum_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Lei , HU Fengqing , WANG Mingsong , XIAO Haibo ,  LI Guoqing , MEI Ju

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P.R.China;

Corresponding author：

LI Guoqing, Email: liguoqing@xinhuamed.com.cn

Keywords：

Surgical design; novel modified Nuss procedure; pectus excavatum; treatment

DOI：

10.7507/1007-4848.201906025

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the surgical design and efficacy of novel modified Nuss procedure for pectus excavatum (PE).Methods We retrospectively analyzed the clinical data of 903 patients with PE who were treated by the new kind of steel bar and the novel modified Nuss procedure. There were 716 males and 187 females at mean age of 2-45 (12.1±6.8) years. Preoperative chest CT scans Haller index (HI) was 3.1-15.2 (4.6±1.3), with 38 patients of mild PE (HI<3.2), 302 patients of moderate PE (HI 3.2-3.5), 521 patients of severe PE (HI 3.6-6.0), and 42 patients of extremely severe PE (HI>6.0). The operative time, operative blood loss, hospital stay time as well as postoperative complications were reviewed and analyzed.Results All of the 903 patients successfully completed the surgery. The mean operative time was 20-45 (25.2±2.6) min for primary PE and that for special type of PE (including recurring PE, PE patients after heart disease operation and those corrected by 2 bars) was 48-150 (63.5±28.1) min. Blood loss was less than 10 mL for primary PE and 15-50 (23.5±5.5) mL for special type of PE. Postoperative hospital stay was 3-15 (4.5±1.6) d. A total of 845 patients (93.6%) required 1 steel bar insertion, 58 patients (6.4%) required 2 steel bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 805 patients, good in 84 patients, fair in 14 patients and poor in 0. The good quality rate was 98.4%.Conclusion Novel modified Nuss procedure can simplify and optimize the surgical design with good short and mid-term effects.

Citation： WANG Lei, HU Fengqing, WANG Mingsong, XIAO Haibo, LI Guoqing, MEI Ju. Surgical design and novel modified Nuss procedure for pectus excavatum. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 900-906. doi: 10.7507/1007-4848.201906025 Copy

1.	Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Ann Cardiothorac Surg, 2016, 5(5): 422-433.
2.	Abid I, Ewais MM, Marranca J, et al. Pectus excavatum: a review of diagnosis and current treatment options. J Am Osteopath Assoc, 2017, 117(2): 106-113.
3.	Pilegaard H, Licht PB. Minimal invasive repair of pectus excavatum and carinatum. Thorac Surg Clin, 2017, 27(2): 123-131.
4.	Graves CE, Hirose S, Raff GW, et al. Magnetic mini-mover Procedure for pectus excavatum Ⅳ: FDA sponsored multicenter trial. J Pediatr Surg, 2017, 52(6): 913-919.
5.	Tikka T, Kalkat MS, Bishay E, et al. A 20-year review of pectus surgery: an analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg, 2016, 23(6): 908-913.
6.	Zhang DK, Tang JM, Ben XS, et al. Surgical correction of 639 pectus excavatum cases via the Nuss procedure. J Thorac Dis, 2015, 7(9): 1595-1605.
7.	Li G, Jiang Z, Xiao H, et al. A novel modified Nuss procedure for pectus excavatum: a new steel bar. Ann Thorac Surg, 2015, 99(5): 1788-1792.
8.	Oncel M, Sunam GS, Yildiran H. Surgical repair of pectus excavatum. Ann Thorac Surg, 2016, 102(5): 1763-1764.
9.	Del Frari B, Schwabegger AH. Clinical results and patient satisfaction after pectus excavatum repair using the MIRPE and MOVARPE technique in adults: 10-year experience. Plast Reconstr Surg, 2013, 132(6): 1591-1602.
10.	Li S, Yang D, Ma Y, et al. Hybrid nuss procedure for pectus excavatum with severe retrosternal adhesions after sternotomy. Ann Thorac Surg, 2017, 103(5): 1573-1577.
11.	Erşen E, Demirkaya A, Kılıç B, et al. Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice? Wideochir Inne Tech Maloinwazyjne, 2016, 11(2): 98-104.
12.	胡丰庆, 王磊, 王明松, 等. 新型矫形钢板治疗成人漏斗胸190 例. 中国胸心血管外科临床杂志, 2018, 25(8): 687-690.
13.	Cierpikowski P, Rzechonek A, Blasiak P, et al. Surgical correction of pectus excavatum by the Nuss procedure: a 15-year experience study. Adv Exp Med Biol, 2018, 1047: 31-40.
14.	Jaroszewski DE, Temkit M, Ewais MM, et al. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults. J Thorac Dis, 2016, 8(8): 2102-2110.
15.	Mennie N, Frawley G, Crameri J, et al. The effect of thoracoscopy upon the repair of pectus excavatum. J Pediatr Surg, 2018, 53(4): 740-743.
16.	王磊, 胡丰庆, 胡睿, 等. 新改良 Nuss 手术矫治先天性心脏病术后漏斗胸的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(3): 213-217.

1. Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Ann Cardiothorac Surg, 2016, 5(5): 422-433.
2. Abid I, Ewais MM, Marranca J, et al. Pectus excavatum: a review of diagnosis and current treatment options. J Am Osteopath Assoc, 2017, 117(2): 106-113.
3. Pilegaard H, Licht PB. Minimal invasive repair of pectus excavatum and carinatum. Thorac Surg Clin, 2017, 27(2): 123-131.
4. Graves CE, Hirose S, Raff GW, et al. Magnetic mini-mover Procedure for pectus excavatum Ⅳ: FDA sponsored multicenter trial. J Pediatr Surg, 2017, 52(6): 913-919.
5. Tikka T, Kalkat MS, Bishay E, et al. A 20-year review of pectus surgery: an analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg, 2016, 23(6): 908-913.
6. Zhang DK, Tang JM, Ben XS, et al. Surgical correction of 639 pectus excavatum cases via the Nuss procedure. J Thorac Dis, 2015, 7(9): 1595-1605.
7. Li G, Jiang Z, Xiao H, et al. A novel modified Nuss procedure for pectus excavatum: a new steel bar. Ann Thorac Surg, 2015, 99(5): 1788-1792.
8. Oncel M, Sunam GS, Yildiran H. Surgical repair of pectus excavatum. Ann Thorac Surg, 2016, 102(5): 1763-1764.
9. Del Frari B, Schwabegger AH. Clinical results and patient satisfaction after pectus excavatum repair using the MIRPE and MOVARPE technique in adults: 10-year experience. Plast Reconstr Surg, 2013, 132(6): 1591-1602.
10. Li S, Yang D, Ma Y, et al. Hybrid nuss procedure for pectus excavatum with severe retrosternal adhesions after sternotomy. Ann Thorac Surg, 2017, 103(5): 1573-1577.
11. Erşen E, Demirkaya A, Kılıç B, et al. Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice? Wideochir Inne Tech Maloinwazyjne, 2016, 11(2): 98-104.
12. 胡丰庆, 王磊, 王明松, 等. 新型矫形钢板治疗成人漏斗胸190 例. 中国胸心血管外科临床杂志, 2018, 25(8): 687-690.
13. Cierpikowski P, Rzechonek A, Blasiak P, et al. Surgical correction of pectus excavatum by the Nuss procedure: a 15-year experience study. Adv Exp Med Biol, 2018, 1047: 31-40.
14. Jaroszewski DE, Temkit M, Ewais MM, et al. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults. J Thorac Dis, 2016, 8(8): 2102-2110.
15. Mennie N, Frawley G, Crameri J, et al. The effect of thoracoscopy upon the repair of pectus excavatum. J Pediatr Surg, 2018, 53(4): 740-743.
16. 王磊, 胡丰庆, 胡睿, 等. 新改良 Nuss 手术矫治先天性心脏病术后漏斗胸的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(3): 213-217.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical design and novel modified Nuss procedure for pectus excavatum

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content