A novel modified Nuss procedure without plate turnover for treatment of adult recurrent pectus excavatum_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Xiao , MEI Ju , LI Guoqing , XIAO Haibo , BI Rui ,  JIANG Lianyong

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

Corresponding?author：

JIANG Lianyong, Email: jianglianyong@xinhuamed.com.cn

Keywords：

Recurrent pectus excavatum; non-turnover plate; adults; surgery

DOI：

10.7507/1007-4848.202009072

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Objective To summarize the experience of treating adult recurrent pectus excavatum without plate turnover.Methods Twenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation.Results All patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum.Conclusion The treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.

Citation： XIE Xiao, MEI Ju, LI Guoqing, XIAO Haibo, BI Rui, JIANG Lianyong. A novel modified Nuss procedure without plate turnover for treatment of adult recurrent pectus excavatum. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1212-1215. doi: 10.7507/1007-4848.202009072 Copy

1.	Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
2.	李國慶, 梅舉, 丁芳寶, 等. 新改良NUSS手術臨床應用初步體會. 中華小兒外科雜志, 2013, 34(7): 493-496.
3.	胡豐慶, 王磊, 王明松, 等. 新型矯形鋼板治療成人漏斗胸190例. 中國胸心血管外科臨床雜志, 2018, 25(8): 687-690.
4.	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.
5.	張娜, 曾騏, 陳誠豪, 等. 漏斗胸復發的原因和治療113例分析. 中華小兒外科雜志, 2012, 33(9): 692-694.
6.	Park HJ, Lee SY, Lee CS, et al. The Nuss procedure for pectus excavatum: Evolution of techniques and early results on 322 patients. Ann Thorac Surg, 2004, 77(1): 289-295.
7.	Uemura S, Nakagawa Y, Yoshida A, et al. Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int, 2003, 19(3): 186-189.
8.	Stanfill AB, DiSomma N, Henriques SM, et al. Nuss procedure: Decrease in bar movement requiring reoperation with primary placement of two bars. J Laparoendosc Adv Surg Tech A, 2012, 22(4): 412-415.
9.	Toci GR, Davis TA, Bigelow BF, et al. Analyzing outcomes of Nuss and Ravitch repair for primary and recurrent pectus excavatum in adults. Ann Thorac Surg, 2020, 110(1): 272-275.
10.	王磊, 鐘竑, 李國慶, 等. 改良Ravitch手術治療成人復發性漏斗胸. 中國胸心血管外科臨床雜志, 2010, 17(6): 520-521.
11.	Kocher GJ, Gstrein N, Jaroszewski DE, et al. Nuss procedure for repair of pectus excavatum after failed Ravitch procedure in adults: Indications and caveats. J Thorac Dis, 2016, 8(8): 1981-1985.
12.	Durry A, Gomes Ferreira C, Tricard T, et al. Minimally invasive repair of pectus excavatum in children: Results of a modified Nuss procedure. Ann Chir Plast Esthet, 2017, 62(1): 8-14.
13.	Yoon YS, Kim HK, Choi YS, et al. A modified Nuss procedure for late adolescent and adult pectus excavatum. World J Surg, 2010, 34(7): 1475-1480.
14.	Guo L, Mei J, Ding F, et al. Modified Nuss procedure in the treatment of recurrent pectus excavatum after open repair. Interact Cardiovasc Thorac Surg, 2013, 17(2): 258-262.
15.	Long LH, Fu LJ, Jing Z, et al. Modified Nuss procedure is a safe choice for recurrent pectus excavatum after previous open repair experience of 26 cases. Pediatr Surg Int, 2013, 29(6): 597-600.

1. Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
2. 李國慶, 梅舉, 丁芳寶, 等. 新改良NUSS手術臨床應用初步體會. 中華小兒外科雜志, 2013, 34(7): 493-496.
3. 胡豐慶, 王磊, 王明松, 等. 新型矯形鋼板治療成人漏斗胸190例. 中國胸心血管外科臨床雜志, 2018, 25(8): 687-690.
4. 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.
5. 張娜, 曾騏, 陳誠豪, 等. 漏斗胸復發的原因和治療113例分析. 中華小兒外科雜志, 2012, 33(9): 692-694.
6. Park HJ, Lee SY, Lee CS, et al. The Nuss procedure for pectus excavatum: Evolution of techniques and early results on 322 patients. Ann Thorac Surg, 2004, 77(1): 289-295.
7. Uemura S, Nakagawa Y, Yoshida A, et al. Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int, 2003, 19(3): 186-189.
8. Stanfill AB, DiSomma N, Henriques SM, et al. Nuss procedure: Decrease in bar movement requiring reoperation with primary placement of two bars. J Laparoendosc Adv Surg Tech A, 2012, 22(4): 412-415.
9. Toci GR, Davis TA, Bigelow BF, et al. Analyzing outcomes of Nuss and Ravitch repair for primary and recurrent pectus excavatum in adults. Ann Thorac Surg, 2020, 110(1): 272-275.
10. 王磊, 鐘竑, 李國慶, 等. 改良Ravitch手術治療成人復發性漏斗胸. 中國胸心血管外科臨床雜志, 2010, 17(6): 520-521.
11. Kocher GJ, Gstrein N, Jaroszewski DE, et al. Nuss procedure for repair of pectus excavatum after failed Ravitch procedure in adults: Indications and caveats. J Thorac Dis, 2016, 8(8): 1981-1985.
12. Durry A, Gomes Ferreira C, Tricard T, et al. Minimally invasive repair of pectus excavatum in children: Results of a modified Nuss procedure. Ann Chir Plast Esthet, 2017, 62(1): 8-14.
13. Yoon YS, Kim HK, Choi YS, et al. A modified Nuss procedure for late adolescent and adult pectus excavatum. World J Surg, 2010, 34(7): 1475-1480.
14. Guo L, Mei J, Ding F, et al. Modified Nuss procedure in the treatment of recurrent pectus excavatum after open repair. Interact Cardiovasc Thorac Surg, 2013, 17(2): 258-262.
15. Long LH, Fu LJ, Jing Z, et al. Modified Nuss procedure is a safe choice for recurrent pectus excavatum after previous open repair experience of 26 cases. Pediatr Surg Int, 2013, 29(6): 597-600.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A novel modified Nuss procedure without plate turnover for treatment of adult recurrent pectus excavatum

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