Nuss Procedure For Pectus Excavatum Research Articles

Intercostal nerve cryoablation versus thoracic epidural analgesia for minimal invasive Nuss repair of pectus excavatum: a protocol for a randomised clinical trial (ICE trial)

IntroductionEpidural analgesia is currently considered the gold standard in postoperative pain management for the minimally invasive Nuss procedure for pectus excavatum. Alternative analgesic strategies (eg, patient-controlled analgesia and paravertebral nerve...

Intercostal Nerve Cryoablation or Epidural Analgesia for Multimodal Pain Management after the Nuss Procedure: A Cohort Study.

Nuss procedure for pectus excavatum is a minimally invasive, but painful procedure. Recently, intercostal nerve cryoablation has been introduced as a pain management technique. In this cohort study, we compared the efficacy of multimodal pain management strategies in children undergoing a Nuss procedure. The effectiveness of intercostal nerve cryoablation combined with patient-controlled systemic opioid analgesia (PCA) was compared with continuous epidural analgesia (CEA) combined with PCA. The study was conducted between January 2019 and July 2022. Primary outcome was length of stay (LOS), and secondary outcomes were operation room time, postoperative pain, opioid consumption, and gabapentin use. Sixty-six consecutive patients were included, 33 patients in each group. The cryoablation group exhibited lower Numeric Rating Scale (NRS) pain scores on postoperative day 1 and 2 (p = 0.002, p = 0.001) and a shorter LOS (3 vs. 6 days (p < 0.001). Cryoablation resulted in less patients requiring opioids at discharge (30.3 vs. 97.0%; p < 0.001) and 1 week after surgery (6.1 vs. 45.4%; p < 0.001)). In the CEA group, gabapentin use was more prevalent (78.8 vs. 18.2%; p < 0.001) and the operation room time was shorter (119.4 vs. 135.0 minutes; p < .010). No neuropathic pain was reported. Intercostal nerve cryoablation is a superior analgesic method compared with CEA, with reduced LOS, opioid use, and NRS pain scores. The prophylactic use of gabapentin is redundant.

Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience.

We aimed to assess the effectiveness of the Nuss procedure for pectus excavatum (PE) and explore the impacts of sex and age on outcomes. We retrospectively reviewed 594 consecutive children ≤18 years of age who underwent the thoracoscopy-assisted Nuss technique between January 2006 and July 2019. The severity of pectus deformity was calculated according to the Haller index (HI). The classification of PE and clinical data including complications was analyzed. Of the 594 patients, 456 (76.8%) were boys and 138 (23.2%) were girls. The mean age at surgery was 10.0 ± 5.0 years. The most common types of PE were 1A and 2A2 according to Park classification. Intraoperative and postoperative complication rates were 2/594 (0.3%) and 74/594 (12.5%), respectively. The most common complication was bar displacement. The bar was removed in 414 patients 3.5 ± 0.8 years later. The mean preoperative HI, postoperative HI with bar, and HI after bar removal were 4.2 ± 1.7, 2.4 ± 0.3, and 2.7 ± 0.5, respectively. Compared to the preoperative HI, both the postoperative HI with bar and HI after bar removal were significantly lower ( p < 0.001). For preschool-age children, the preoperative HI was significantly higher ( p = 0.027) and the change in HI significantly improved compared to school-age children ( p = 0.004). Boys and adolescents needed significantly more bars and stabilizers. Surgical correction of PE using the Nuss procedure is a safe procedure and improves the HI in children of different ages, even in those younger than 6 years of age.

Outcomes of the minimally invasive nuss procedure for pectus excavatum

Because of some disadvantages of the "Ravitch method," which is the classical open surgical method used for many years in the treatment of pectus excavatum (PE), as an alternative to it, a minimally invasive surgical method called the “Nuss procedure” has been developed. This procedure has become the most preferred surgical method in the treatment of PE in recent years. In our study, we aimed to share the results of the “Nuss procedure” that we applied to our patients with PE in light of the literature. The files of 77 patients who underwent a Nuss operation for PE in our clinic between July 2007 and March 2023 were evaluated retrospectively. The age, gender, surgical method, complications, and length of hospital stay of the patients were recorded. The median age was 17.71±4.84 years (range, 2.5-33) and the majority of patients were male (63 males, 14 females). As symptoms, 14 (18.2%) patients had dyspnea, 32 (41.5%) had chest pain, and almost all patients had psychosocial problems. While minimal pneumothorax was the most common early postoperative complication (n=18, 23.4%), bar dislocation was the most common late complication (n=5, 6.5%). None of the patients had serious complications such as death, organ injury, or massive bleeding during the operations. We think that the Nuss procedure, which is a minimally invasive approach, can be safely applied to selected patients due to its short operation time, low complication rate, and success in correcting the deformity.

Combined Ravitch and Nuss procedure for pectus excavatum with dyspnea following scoliosis repair

Abstract Pectus excavatum (PE) is often associated with scoliosis and can elicit cardiovascular disturbances under rare conditions. Here we report a patient who was treated with a combined Ravitch and Nuss procedure for PE with dyspnea following scoliosis repair to improve her symptoms. The patient was a 49-year-old woman with a history of PE and scoliosis. Right inferior pulmonary vein stenosis was caused by posterior spinal fusion for scoliosis prior to the PE repair. We could safely correct the chest wall deformity and treat dyspnea by performing a modified Ravitch repair in combination with the Nuss procedure.

Application of an ultrasound-guided bilateral erector spinae plane block after the Nuss procedure for pectus excavatum in children: a retrospective cohort study with propensity score matching.

To retrospectively analyze the effect of applying an ultrasound-guided bilateral erector spine plane block (ESPB) after the Nuss procedure for surgical repair of pectus excavatum (PE) in children. The subjects of the study were patients with severe PE who received the Nuss procedure in our hospital between 1 January 2019 and 30 November 2021. According to different methods for postoperative pain management, the enrolled patients were divided into two groups, the ultrasound-guided ESPB group and the thoracic epidural analgesia (TEA) group. The primary outcome of this study was analgesic drug dosage and the secondary outcome was numerical rating scales (NRSs) between the two groups. There was no significant difference between the two groups in terms of demographic, preoperative clinical evaluation, or surgical characteristics (P > 0.05). The catheter duration in the TEA group was significantly shorter than that in the ESPB group (P < 0.05), while the hospitalization time in the ESPB group was significantly shorter than that in the TEA group (P < 0.05). In terms of oral morphine equivalent comparison, the required dose of the TEA group was lower than that of the ESPB group on the 1st and 2nd day after the operation (P < 0.05), and there was no statistical difference between the two groups on the 3rd and 4th day after the operation (P > 0.05). The number of patients with an S-NRS ≥ 7 and D-NRS ≥ 7 in the TEA group at day 1 was lower than that in the ESPB group (P < 0.05). There was no significant difference between the two groups at other time points (P > 0.05). An ultrasound-guided ESPB used in Nuss surgery for children with funnel chest can provide good analgesia for surgery and shorten the postoperative rehabilitation and hospitalization time of patients. It is a safe and effective alternative to TEA.

What Is the Appropriate Timing for Bar Removal After the Nuss Repair for Pectus Excavatum?

IntroductionThe Nuss procedure for pectus excavatum requires that the sternal elevation be maintained by indwelling metal bars that are traditionally removed approximately 3 y after the repair. MethodsA retrospective cohort study was conducted of all patients who underwent primary Nuss repair from 2007 to 2018 in two institutions and had a follow-up of at least 24 mo. Pectus bars had been left in place beyond 3 y in patients concerned over possible recurrence after bar removal. Structured interviews were held to assess pain, chest tightness, or other discomfort, and any adverse events related to pectus bars. Results were compared between patients in whom pectus bars were removed after 3 y (standard group) and those in whom bars were left in place longer (extended bar duration group). ResultsTwo hundred and thirty-one patients (91% males, mean age 23.9 ± 8.3, mean Haller index 4.9 ± 2.3) were included. Bar duration was 30.6 ± 6.6 mo in the standard group (51 patients) versus 69.1 ± 26.3 mo in the extended group (180 patients). Some discomfort was reported by 81.6% in the standard group versus 62.9% in the extended group (P = 0.033), and discomfort occurring at least monthly or more often was only reported by 30% in the standard versus 30.3% in the extended group (P = 1.000). Quality of life improved in 92.6% of the standard group versus 94.7% of the extended group (P = 1.000). No significant adverse events were reported in either group. ConclusionsOur data suggest that an extended bar duration after the Nuss repair may not cause any adverse event nor negatively affect quality of life.

Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure

Pectus excavatum is the most common congenital chest wall abnormality, with the Nuss procedure being the most commonly performed repair. Pain control is the predominant factor in the postoperative treatment of these patients. This study aims to compare the cost and outcomes of intercostal nerve cryoablation (INC) and thoracic epidural (TE) in patients undergoing the Nuss procedure. A retrospective chart review was conducted at our institution for all patients who underwent the Nuss procedure for pectus excavatum from 2002 to 2020. Patients were stratified by pain management strategy, INC vs. TE. Chi-square and Fisher's exact were used to compare categorical variables. Wilcoxon tests were used to evaluate continuous variables and costs. A total of 158 patients were identified. Of these, 80.4% (N=127) were treated with epidural, while 19.6% (N=31) were treated with intercostal nerve cryoablation. The INC group had lower rates of PCA use (35.5% vs. 93.7%, p<0.001), lower total morphine milligram equivalent requirement (27.0 vs. 290.8, p<0.001), and shorter length of stay (3.2 days vs. 5.3 days, p<0.001) compared to the TE group. INC was also associated with longer operative times (153.0min vs. 89.0min, p<0.001). The total hospitalization cost for the INC group was higher compared to the TE group ($24,742.5 vs $21,621.9, p=0.001). In patients undergoing the Nuss procedure, compared to thoracic epidural, INC was associated with lower opioid use and shorter length of stay but at the cost of longer operative time and increased hospitalization cost. Treatment Study, Level III.

Rhabdomyolysis following Nuss Procedure: A Prospective Study in Children.

Postoperative rhabdomyolysis (RML) has been documented after several surgical procedures in adults. Musculoskeletal remodeling after Nuss procedure for pectus excavatum (PE) could cause RML. We evaluated the incidence of RML after Nuss procedure in children. This study was a prospective study from 2018 to 2021. We enrolled all otherwise healthy patients who underwent PE correction with only one bar. Studied variables included demographic and clinical data, duration of surgery, complications, and length of hospitalization. The patients included underwent serial measurements of serum creatine kinase (CK), troponin I, N terminal pro B-type natriuretic peptide (NT-proBNP), serum creatinine, urea, and glomerular filtration rate at 6 and 48 hours postoperatively, and hospital discharge. Forty-six patients met criteria (40 males/6 females), with a mean age of 15.1 ± 1.4 years. Mean duration of surgery was 74 ± 28 minutes, and length of hospitalization was 4.6 ± 1.6 days. RML was diagnosed in 30.4% of patients at 6 hours, 91.3% at 48 hours, and 21.7% at hospital discharge. Mean preoperative CK value was 181.1 ± 141.6 IU/L, and postoperative values were 863.3 ± 302.6 IU/L at 6 hours, 1,675.2 ± 561 IU/L at 48 hours, and 850 ± 683.7 IU/L at hospital discharge, with statistically significant differences (p = 0.001). High-sensitivity troponin I and NT-proBNP levels increased significantly during the postoperative time (p = 0.001). Renal function remained stable (p = 0.55). Nuss technique produces RML without kidney injury in healthy patients. This knowledge should be considered for patients at increased risk of developing acute kidney injury and other complications.

Cryoablation in 350 Nuss Procedures: Evolution of Hospital Length of Stay and Opioid Use

IntroductionCurrent studies show cryoablation decreases opioid requirements and lengths of stay (LOS) in patients undergoing the Nuss procedure for pectus excavatum. This study evaluated the relationship between cryoablation and clinical outcomes for the Nuss procedure. MethodsA retrospective single-center chart review was performed on patients undergoing the Nuss procedure with intercostal cryoablation from December 2017-August 2021. Demographics, hospital course, and postoperative complications were abstracted. To evaluate the evolution of outcomes over time, the earliest quarter (Q1) of cryoablation patients was compared to the last quarter (Q4). ResultsOver 45 months, 350 Nuss procedures with cryoablation were performed. The mean age at operation was 15.7 ± 2.3 years with an average Haller Index of 5.4 ± 4.2. The mean operative time was 136 ± 40.5 minutes. On average, patients used 2.8 ± 2.5 OME/kg of opioid in hospital with a LOS of 2.7 ± 1.1 days. The Q4 patients were discharged 1.3 days earlier (p<0.05) than Q1 patients, with 80% of Q4 discharged by postoperative day #2 vs. 23% in Q1 (p<0.05). Q4 patients received 74% (p<0.05) less opioid in hospital and 21% (p<0.05) less on discharge. Within 90 days postoperatively, complication rates (chest tube placement, wound infection, readmission, neuropathic pain) were similar. Only two patients (0.6%) required reoperation for bar migration/slippage. ConclusionWith increased experience, cryoablation for the Nuss procedure decreased opioid use by 74% and was associated with 80% of patients achieving early discharge. Major complication rates were not increased. Cryoablation can be successfully implemented as an effective method of postoperative analgesia. Level of EvidenceLevel III

Separation of the seventh costal-sternal junction−A new technique to improve outcomes for the Nuss procedure for pectus excavatum

In the standard Nuss procedure for pectus excavatum, the costal arch is often elevated together with the sternum, resulting in unevenness of the lower part of the thorax. This complication is commonly called rib flaring. This paper presents a technique to avoid rib flaring and evaluates its effectiveness. In our technique, a part of the seventh costal cartilage is removed, disconnecting the costal arch from the sternum. The effectiveness of this technique was evaluated in a retrospective clinical study of 63 pectus excavatum patients who were randomly collected and were divided into two groups. One group-defined as the Standard Group-includes 27 patients (29.8±6.5SD y/o) on whom standard Nuss procedure was conducted; the other group-defined as the Separation Group-includes 36 patients (31.8±6.1SD y/o) on whom the cartilage removal was conducted in addition to the standard Nuss procedure. The degree of postoperative costal-arch elevation was defined as ECA (Elevation of Costal Arch) and was compared between the two groups. ECA was significantly greater for the Standard Group (10.2±3.3SD mm) than for the Separation Group (-1.1±3.42SDmm). Postoperative protrusion of the costal arch is prevented by the separation of the seventh costal cartilage from the sternum. Our original technique is a useful option for the treatment of pectus excavatum.

Wang procedure: A reasonable choice for reoperation after failure of Nuss procedure for pectus excavatum

Pectus excavatum is a common thoracic deformity, and Nuss procedure is considered as the standard operation for the treatment of this deformity. However, there are often cases of Nuss procedure failure in the clinic. Once such a situation occurs, it often needs to be operated again. Since Nuss procedure can cause adhesions behind the sternum and in the bilateral thoracic cavities, if Nuss procedure is still used in the reoperation, it is not only very difficult, but also possible to cause heart and lung injuries. Therefore, Nuss procedure is not an ideal choice for reoperation. Wang procedure is a new method to treat the deformity of depressed chest wall. Since this operation is mainly performed outside the chest wall and rarely involves the structures in thoracic cavity, it is suitable for reoperation after the failure of Nuss procedure. This article reports a 12-year-old boy who had a failed Nuss procedure. We used Wang procedure for treatment and achieved satisfactory results.

Health-related quality of life after Nuss procedure for pectus excavatum: a cross-sectional study.

OBJECTIVESPectus excavatum (PE) can cause both physical and psychosocial symptoms and affect patients’ health-related quality of life. Previous international studies have shown that the Nuss procedure increases both self-esteem and body image. The aim of the study was to evaluate the health-related quality of life in patients who have undergone the Nuss procedure for PE.METHODSThe study had a cross-sectional multicentre design. All patients (N = 420) who underwent the Nuss procedure for PE in 3 cardiothoracic departments in Sweden from 2000 to 2019 were invited to answer the RAND-36 and Nuss Questionnaire modified for adults. Genders were compared using the Mann–Whitney U-test. Patients were divided into groups based on age at time of surgery (<20, 20–30 or >30 years) and analysed by the Kruskal–Wallis H-test with post-hoc analyses.RESULTSA total of 236 patients returned the questionnaires; 82.2% were males. Men scored significantly better on the modified Nuss Questionnaire total (P = 0.01) and psychosocial (P = 0.02) subscales. Patients who had surgery at <20 years of age had significantly better scores on the same scales (P = 0.007 and 0.006, respectively) compared to patients aged 20–30 years at the time of surgery. However, no significant difference was seen in comparison with patients >30 years. Patients who had their bar removed had significantly better values on both scales.CONCLUSIONSMale gender, young age at surgery and bar removal seem to be associated with better health-related quality of life after the Nuss procedure for PE.

Intraoperative Methadone Reduces Postoperative Opioid Requirements in Nuss Procedure for Pectus Excavatum.

Surgical correction of pectus excavatum by Nuss procedure, commonly referred to as minimally invasive repair of pectus excavatum (MIRPE), often results in significant postoperative pain. This study investigated whether adding intraoperative methadone would reduce the postoperative opioid requirement during admission for patients undergoing MIRPE. A retrospective cohort chart review was conducted for 40 MIRPE patients between 2018 and 2020. Patients were stratified into 2 groups: those who received multimodal anesthesia (MM, n = 20) and those who received multimodal anesthesia with the addition of intraoperative methadone (MM + M, n = 20). Data collected included total opioid consumption during hospital stay (morphine milligram equivalents [MMEs]), hospital length of stay (LOS), pain scores, time to ambulation, and time to tolerating solid food. Addition of intraoperative methadone for patients undergoing MIRPE significantly reduced postoperative opioid requirements (MME/kg) during admission (P = .007). On average, patients in the MM group received 1.61 ± .55MME/kg while patients in the MM + M group received 1.16 ± .44MME/kg. Hospital opioid (non-methadone) total was also significantly reduced between the MM (1.87 ± .54) and MM + M group (1.37 ± .46), P = .003. There was no significant difference in hospital opioid total MME/kg administered between the groups. There were no significant differences observed in hospital LOS, pain scores, time to ambulation, or time to toleration of solid food. Incorporating intraoperative methadone for patients undergoing MIRPE reduced postoperative opioid requirements and hospital opioid (non-methadone) totals without a significant change in pain scores. Patients undergoing the Nuss procedure may benefit from the administration of intraoperative methadone.

Next day discharge after the Nuss procedure using intercostal nerve cryoablation, intercostal nerve blocks, and a perioperative ERAS pain protocol

BackgroundThe Nuss procedure for pectus excavatum has historically been associated with significant postoperative pain, which has been the major factor contributing to hospital length of stay (LOS). MethodsA single-institution, prospective study of 40 consecutive patients undergoing Nuss bar placement for pectus excavatum between November 2019 and January 2021 was conducted to assess the effectiveness of a multimodality pain management protocol. All patients received T3-T8 intercostal nerve cryoablation (INC), T3-T8 bupivacaine intercostal nerve blocks, Exparel at the skin incisions, and management with a perioperative analgesia regimen that minimized narcotic usage. The primary outcome was LOS. Secondary outcomes included opioid use, pain scores, and time to sensory recovery. Results37/40 patients (92.5%) were discharged home on postoperative day (POD) 1, and 3/40 (7.5%) were discharged on POD 2 (mean LOS = 1.1 days). The median average postoperative pain score was 2/10. After eliminating IVPCA from our protocol, total oral morphine equivalent (OME) decreased by 73% (55.5 mg to 15 mg) with no change in pain scores or discharge timing. ConclusionsINC combined with bupivacaine intercostal nerve blocks and a pre- and post-hospital analgesia protocol facilitated discharge one day after the Nuss procedure, achieved excellent pain control, and eliminated the need for intravenous opioids.

Preventing bar-related complications for chest wall deformities

Aim: Nuss procedure for pectus excavatum and Abramson procedure for pectus carinatum are used as minimally invasive methods for surgical treatment of chest wall defomities. The aim of this study is to investigate the causes of bar-related complications, and to present technical details of their management. Materials and Methods: Patients who underwent minimally invasive correction surgery with the diagnosis of pectus excavatum and pectus carinatum between 2011-2020 in our clinic were included in this study. The surgical treatments, bar related complications, and follow-up records of patients were recorded and analyzed retrospectively. Results: 141 patients with a mean age of 16.08 ± 4.38 were included in the study. Postoperative bar-related complications were encountered in 28 (19.8%) of all patients. There were no life-threatening early or late complications. The most common complication was skin reaction in 7 (4.9%) cases. Conclusion: Bar-related complications are problems that can cause morbidity and disrupt patient comfort, thus management of complications should be focused on.

Clinical results of Nuss procedure for pectus excavatum in different age groups

Aim: In 1998, Donald Nuss suggested the insertion of a metal bar behind the sternum for pectus excavatum as a minimally invasive technique. However, data regarding the relation between the age of the patient and clinical results of repair is limited. Aim of this study is to compare the clinical results of Nuss surgery for pectus excavatum in different age groups, to point out the optimal range of age for this procedure.&#x0D; Material and Methods: From February 2012 to January 2020, data regarding 140 patients have been treated with Nuss surgery. We classified patients into three groups: patients younger than 15 years (group A), patients between 15 and 20 years (group B); and patients older than 20 years up to 40 years (group C) retrospectively. We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates.&#x0D; Results: One hundred ten patients were male and 30 were female. Male patients, clinical symptomatic patients with dyspnea in the preoperative period were seen more frequently in patients with older age, and each were statistically significant (p:0.003). In the early 30-day postoperative period, no mortality was observed. The most frequent postoperative complications were observed in group C (40,9%), followed by group B (18,2%) and group A (9,6%)(p:0.007). In logistic regression analysis, postoperative complications increased significantly in patients older than 20 years (p:0.003). Brace therapy was performed for 2 cases in Group A for recurrence after bar removal which occurred in adolescant period.&#x0D; Conclusion: Nuss procedure can be recommended with low complication rates, short term hospitalization and high grade of success. Although the childhood period seems to be more suitable regarding the complications, surgery can be preferred with low recurrence rates in adolescant period.

Translation and psychometric evaluation of the Swedish versions of the Nuss Questionnaire modified for Adults and the Single Step Questionnaire

BackgroundPectus excavatum (PE) is the most common congenital chest wall deformity. Most individuals with PE suffer from psychosocial problems, with low self-esteem and poor body image. Correctional surgery for PE is available, the most widely used is the Nuss procedure. The Nuss procedure has previously been reported to improve self-esteem, body image and health-related quality of life (HRQoL). To assess HRQoL among individuals with PE, the Nuss Questionnaire modified for Adults (NQ-mA) and Single Step Questionnaire (SSQ) has been developed. The aim of the current study was to translate and culturally adapt NQ-mA and SSQ to fit a Swedish context, and to evaluate the psychometric properties, and validate the culturally adapted versions.MethodsIndividuals who had undergone the Nuss procedure for pectus excavatum were invited to participate in a multicentre study with cross-sectional design. HRQoL was assessed by NQ-mA, SSQ and RAND-36. Psychometric properties for NQ-mA and SSQ were evaluated by content validity index and construct validity (exploratory factor analysis, confirmatory factor analysis, and inter-scale correlations). Known-groups validity, as well as floor and ceiling effects, were evaluated. Internal consistency reliability was examined using Cronbach’s alpha.ResultsIn total 236 individuals participated in the study. Content validity index for NQ-mA showed satisfactory results, except for two items. Factor analysis for NQ-mA suggested a two-factor model, with exclusion of two items. Subscales correlated adequately with RAND-36’s domains. Known-groups validity for NQ-mA demonstrated high sensitivity for between-group differences. Ceiling effects were present in several items. Cronbach’s alpha for NQ-mA was .89. Confirmatory factor analysis for SSQ resulted in a three-factor model, with exclusion of five items. However, this model was shown to be unstable through further exploratory factor analysis testing, and no further psychometric tests were conducted for SSQ.ConclusionThe 10-item Swedish version of NQ-mA was shown to be valid for research and clinical assessment of HRQoL in individuals with pectus excavatum. The Swedish version of SSQ requires revision of items before further validation can be performed.

Outcomes of the Nuss procedure for pectus excavatum in adults

Limited data exist with regard to the outcome of the Nuss procedure for pectus excavatum repair in adults. Here, we analysed changes in lung capacity and thoracic morphology based on computed tomography (CT) imaging in adults with pectus excavatum before surgery, during bar insertion and after bar removal. Patients who underwent the Nuss procedure for pectus excavatum after the age of 20 were included in this study. Chest CT scans of the included participants were taken before the Nuss procedure, immediately before removal of the pectus bar and 6 months after removal of the pectus bar. Lung capacity and thoracic morphology measurements were made from the CT scans. Six patients aged 24-43 years were included in this study. After the Nuss procedure, lung capacity was decreased in all patients. Although the pectus bar was removed, lung capacity had not significantly increased and was almost the same volume as before the Nuss procedure. After the Nuss procedure, the funnel chest shape had improved in all cases, patients' thoracic spine had also moved forward as the thorax moved forward and patients' stoop had improved. Despite a lack of change in lung capacity, surgical modification should be considered to reduce stress on the thoracic spine and in turn, reduce pain in patients with pectus excavatum. However, further long-term observation seems necessary.

Nuss Procedure for Pectus Excavatum: A Comparison of Complications Between Young and Adult Patients

The Nuss procedure is the gold standard surgical treatment for pectus excavatum in young patients. Its use in adults has also been described, although it may be associated with increased postoperative morbidity resulting from higher chest wall rigidity. This study aimed to examine the risk of complications after the Nuss procedure in adult patients compared with young patients with pectus excavatum. This single-center retrospective cohort study evaluated all patients who underwent the Nuss procedure between 2006 and 2018. Patients were stratified by age as young (≤24 years old) and adult (>24 years old). The primary end point was the occurrence of perioperative or postoperative complications, subdivided into major (Clavien-Dindo class IIIa or higher) and minor (less severe than Clavien-Dindo class III). Between-group differences were analyzed using the Mann-Whitney U and the χ2 test with post hoc analysis. A total of 327 participants were included, 272 in the young group (median age, 16 years; interquartile range [IQR], 15 to 18 years; range, 11 to 24 years) and 55 in the adult group (median age, 32 years; IQR, 27 to 38 years; range, 25 to 47 years). The median Haller index was similar between groups (young, 3.7; IQR, 3.2 to 4.4 vs adult,3.6; IQR, 3.0 to 4.3; P= .44). The median follow-up was 34 and 36 months, respectively. The incidence of major complications was comparable between young and adult participants (P= .43). Minor complications occurred more often among adults (young, 4% vs adult, 11%; P= .002). Chronic postoperative pain was the only minor complication with a significant difference in incidence (young, 1% vs adult, 7%; P= .008). The Nuss procedure is a safe surgical treatment for pectus excavatum in both young and adult patients. The risk of major complications is comparable. However, adults more often have chronic pain.