Minimally invasive repair of pectus excavatum using the Nuss technique in children and adolescents: Indications, outcomes, and limitations

作者：Kabbaj R^*; Burnier M; Kohler R; Loucheur N; Dubois R; Jouve J L

来源：Orthopaedics & Traumatology-Surgery & Research, 2014, 100(6): 625-630.

DOI：10.1016/j.otsr.2014.05.019

• Pectus excavatum
• Funnel chest
• Child
• Minimally invasive Nuss procedure

Background: Pectus excavatum (PE) is a common congenital deformity. The Nuss technique for minimally invasive repair of PE involves thoracoscopy-assisted insertion of a bar or plate behind the deformity to displace the sternum anteriorly. Our objective here was to clarify the indications and limitations of the Nuss technique based on a review of 70 patients.
Materials and methods: A retrospective review of children managed at two centres identified 70 patients who had completed their growth and had their plate removed. Mean age was 13.8 years (range, 6-19 years). The reason for surgery was cosmetic disfigurement in 66 (95%) patients. The original Nuss technique was used in 63 patients, whereas 7 patients required an additional sub-xiphoid approach. Time to implant removal ranged from 8 months to 3 years.
Results: The cosmetic outcome was considered satisfactory by the patients in 64(91%) cases and by the surgeon in 60(85.7%) cases. Major complications requiring further surgery occurred in 6 (8.5%) patients and consisted of haemothorax (n = 2), chest wall sepsis (n = 2, including 1 after implant removal), allergy (n= 1), and implant displacement (n = 1). Early or delayed minor complications occurred in 46 (65%) patients and resolved either spontaneously or after non-surgical therapy.
Discussion: The minimal scarring and reliably good outcomes support the widespread use of the Nuss technique in children and adolescents. Our complication rates (minor, 65%; and major, 8.5%) are consistent with previous publications. In our opinion, contra-indications to thoracoscopic PE correction consist of a history of cardio-thoracic surgery and the finding by computed tomography of a sternum-to-spine distance of less than 5 cm or of sternum rotation greater than 35 degrees. In these situations, we recommend a sub- and retro-xiphoid approach to guide implant insertion or a classic sterno-chondroplasty procedure.
Level of evidence: Level IV, retrospective descriptive cohort study.

• 出版日期2014-10