Bachiller

Journal of Cardiothoracic Surgery
Review

BioMed Central

Open Access

Peri-operative data on the nuss procedure in children with pectus excavatum: independent survey of the first 20 years' data
Aristotle D Protopapas* and Thanos Athanasiou
Address: Department of Biosurgery & Surgical Technology, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK Email: Aristotle DProtopapas* - aristotelis.protopapas02@ic.ac.uk; Thanos Athanasiou - thanos.athanasiou@ic.ac.uk * Corresponding author

Published: 4 July 2008 Journal of Cardiothoracic Surgery 2008, 3:40 doi:10.1186/1749-8090-3-40

Received: 20 March 2008 Accepted: 4 July 2008

This article is available from: http://www.cardiothoracicsurgery.org/content/3/1/40 © 2008 Protopapas and Athanasiou; licensee BioMedCentral Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Objective: To review the literature and assess the cumulative data on the Nuss operation in children onits twenty years' anniversary: The Nuss procedure corrects the pectus excavatum by minimal access semi-permanent insertion of metal bars in order to reduce the deformity and refashion the contour of the growing thorax. The advantage over previous techniques is avoidance of osteochondrotomies and thence allowance for normal growth of the thorax. Study design: PubMed search was performed. Primaryoutcomes were mortality, morbidity and individual complications. Secondary outcomes were procedure time and hospital stay. Results: We merged the data from 19 reports comprising 1949 children of mean age 10.6 years. No mortality was observed and the procedure was associated with morbidity of 15.4%. The commonest complications are bar-related adverse events (5.7%) and pneumothorax (3.5%). The averageprocedure time and the average hospital stay were 68 minutes and 5.5 days respectively. Conclusion: 20 years of initial evidence suggests that the Nuss group of procedures is a safe minimal access option for correction of pectus excavatum in childhood.

Introduction
The cardiothoracic surgeons are moving towards minimally invasive techniques. Such a technique is the Nuss repair (alias MinimallyInvasive 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 forcardiorespiratory improvement can be considered.

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] andWillital-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
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Journal of Cardiothoracic Surgery 2008, 3:40http://www.cardiothoracicsurgery.org/content/3/1/40

Table 1: Perceived advantages and disadvantages of minimal access strategy for correction of pectus in childhood in comparison to pre-existing conventional techniques

Advantages Short hospital stay Minimal trauma Allowance for skeletal growth

Disadvantages Cost of thoracoscopy and equipment Second procedure for bar removal Capnothorax in thoracoscopy

normal growth of the...