Modified Nuss Operation for Pectus Excavatum: Design for Decreasing Cardiopulmonary Complications

Abstract

Thoracoscopic Nuss operation of funnel chest is increasingly performed. However, it has a high rate of complications. This study developed some modifications to facilitate Nuss operations with the intention of reducing several major complications. Patients who presented for surgical repair of pectus excavatum from July 2003 through June 2004 had a preoperative computed tomography (CT) scan, pulmonary function tests, and cardiac echo before and two months after the modified Nuss operation. The following modifications of the standard Nuss procedure were implemented: (1) One small subxyphoid incision was made to guide the plate implantation and to decrease cardiopulmonary complications. (2) Thoracic muscles were dissected off the ribs to provide muscle pockets. (3) Shorter thick stainless-steel AO bars were selected to avoid thoracic outlet syndrome and restriction. (4) The bars were fixed to adjacent ribs by 4-0 stainless steel wires into the submuscular pockets. (5) No thoracoscope routinely used. (6) No chest tubes were placed to decrease chest pain or for cosmetic purposes. 15 patients aged between 4 and 32 years (mean, 18.6 +/- 7.8) underwent evaluation. Preoperative CT index was 4.14 +/- 0.86. The average operating time was 95.7 +/- 27.0 min. There was no bar dislocation, prolonged pain, or neuralgia. Echocardiography showed no pericarditis and no pneumothorax occurred after placement of the intrathoracic bar. A small subxiphoid incision makes bar implantation easier and has reduced the incidence of major complications in this early experience with 15 patients.