Perioperative strategies and technical modifications to the Nuss repair for pectus excavatum in pediatric patients: A large volume, single institution experience

Maria Grazia Sacco Casamassima, Seth D. Goldstein*, Jose H. Salazar, Kimberly H. McIltrot, Fizan Abdullah, Paul M. Colombani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background The safety and efficacy of minimally invasive pectus excavatum repair have been demonstrated over the last twenty years. However, technical details and perioperative management strategies continue to be debated. The aim of the present study is to review a large single-institution experience with the modified Nuss procedure. Methods A retrospective review was performed of patients who underwent primary pectus excavatum repair at a single tertiary hospital via a modified Nuss procedure that included: no thoracoscopy, retrosternal dissection achieved via a left-to-right thoracic approach, four-point stabilization of the bar, and no routine epidural analgesia. Data collected included demographics, preoperative symptoms, operative characteristics, hospital charges and postoperative outcomes. Results A total of 336 pediatric patients were identified. No cardiac perforations occurred and the rate of pericarditis was 0.6%. Contemporary rates of bar displacement have fallen to 1.2%. Routine use of chlorhexidine scrub reduced superficial site infections to 0.7%. Two patients (0.6%) with severe recurrence required reoperation. Bars were removed after an average period of 31.7(SD 13.2) months, with satisfactory cosmetic and functional results in 94.9% of cases. Conclusions We report here a single-institution large volume experience, including modifications to the Nuss procedure that make the technique simpler and safer, improve results, and minimize hospital charges.

Original languageEnglish (US)
Pages (from-to)575-582
Number of pages8
JournalJournal of pediatric surgery
Volume49
Issue number4
DOIs
StatePublished - Apr 2014

Keywords

  • Chest wall deformities
  • Invasive repair
  • Minimally
  • Nuss procedure
  • Pectus excavatum

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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