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2009 | 81 | 2 | 103-112

Article title

The Nuss Procedure for the Correction of Pectus Excavatum


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Pectus excavatum is one of the most common chest malformation. It occurs 4-5 times more often in boys. Familiar occurrence of the malformation has been observed. Two surgical techniques have been performed predominantly: the Ravitch method (1949) with further modifications and the Nuss minimally invasive method (1998).The aim of the study was presentation of our own, slightly modified surgical technique, its results and original analgesia method in early postoperative period.Material and methods. 190 Nuss procedures have been performer in years 1998-2008. 140 children operated on for the period of 8 years have been analyzed. A slightly modified surgical method and original postoperation intrapleural analgesia method have been presented. No thoracoscopy and no lateral stabilizations have been used. The Haller index of operated children was 2.2-5.8. The children's age was 4-18 years, av. 14 years. An average operation time was 40 min and 80 min together with anesthesia.Results. Very good result was achieved in 72%, good in 22% and bad in 5%. No mortality and inner organ injuries were noticed. Minor complications occurred in 12% of children.Conclusions. The Nuss procedure for the correction of pectus excavatum gives good and very good results in 94% of children. The minimal invasiveness of this method allows to use this method for minor defects. The limitation of this technique is asymmetric defect in which the Ravitch procedure is still the method of choice.








Physical description


1 - 2 - 2009
20 - 3 - 2009


  • Department of Paediatric Surgery, Medical University of Silesia, Upper Silesian Centre for Child Health, Katowice
  • Department of Paediatric Surgery, Medical University of Silesia, Upper Silesian Centre for Child Health, Katowice
  • Department of Anesthesiology, Intensive Care Upper Silesian Centre for Child Health, Katowice


  • Fonkalsrud EW: Current Management of Pectus Excavatum, World J Surg 2003; 27: 502-08.[Crossref][PubMed]
  • Schalamon J, Pokall S, Windhaber J et al.: Minimally invasive correction of pectus excavatum in adult patients. JTCS 2006; 132: 524-29.
  • Lawson ML, Cash TF, Akers R et al.: A pilot Study of the Impact of Surgical Repair on Disease-Specific Quality of Life Among Patients With Pectus Excavatum. J Pediatr Surg 2003; 38: 916-18.[Crossref]
  • Molik KA, Engum SA, Rescoria FJ et al.: Pectus excavatum repair: Experience with standard and minimal invasive techniques. J Pediatr Surg 2001; 36: 324-28.[Crossref]
  • Nordquist J, Svensson H, Johnsson M: Silastic Implant for Reconstruction of Pectus Excavatum: An Update. Scand J Plast Reconstr Hand Surg 2001; 35: 65-69.
  • Roberts J, Hayashi A, Anderson JO et al.: Quality of Life of Patients Who Have Undergone the Nuss Procedure for Pectus Excavatum: Preliminary Findings. J Pediatr Surg 2003; 38: 779-83.[Crossref]
  • Creswick HA, Stacey MW, Kelly RE et al.: Family study of the inheritance of pectus excavatum. J Pediatr Surg 2006; 41: 1699-03.[Crossref]
  • Nuss D, Kelly RE, Croitoru DP et al.: A 10-Year Review of a Minimalny Invasive Technique For the Correction of Pectus Excavatum. J Pediatr Surg 1998; 33: 1-9.
  • Bohosiewicz J, Kudela G, Izwaryn U i wsp.: Nowa metoda operacji lejkowatej klatki piersiowej - doniesienie wstępne. Chirurgia dziecięca 2000; 1: 18-20.
  • Bohosiewicz J, Kudela G, Koszutski T: Results of Nuss Procedures for the Correction of Pectus Excavatum. Eur J Pediatr Surg 2005; 15: 6-10.[Crossref][PubMed]
  • Croitou DP, Kelly RE, Goretsky MJ et al.: Experience and Modification Update for the Minimally Invasive Nuss Technique for Pectus Excavatum Repair in 303 Patients. J Pediatr Surg 2002; 37: 437-45.[Crossref]
  • Coln D, Gunning T, Ramsay M: Early Experience with the Nuss Minimally Invasive Correction of Pectus Excavatum in Adults. World J Surg 2002; 26: 1217-21.[Crossref][PubMed]
  • Dzielicki J, Korlacki W, Janicka I et al.: Difficulties and limitations In minimalny invasive repair of pectus excavatum - 6 years experiences with Nuss technique. Eur J Cardiothorac Surg 2006; 30: 801-04.
  • Molik KA, Engum SA, Rescorla FJ et al.: Pectus Excavatum Repair: Experience With Standard and Minima Invasive Techniques. J Pediatr Surg 2001; 36: 324-28.[Crossref]
  • Boehm RA, Muenstrerer OJ, Till H: Comparing Minimally Invasive Funnel Chest Repair versus the Conventional Technique: An Outcome Analysis in Children. Plast Reconstr Surg 2004; 114: 668-73.[Crossref][PubMed]
  • Fonkalsrud EW, Beanes S, Hebra A et al.: Comparison of Minimally Invasive and Modified Ravitsch Pectus Excavatum Repair. J Pediatr Surg 2002; 37: 413-17.[Crossref]
  • Fonkalsrud EW: Open repair of Pectus Excavatum with Minimal Cartilage Resection. Ann Surg 2004; 240: 231-35.[PubMed][Crossref]
  • Davis JT, Weinstein S: Repair of the Pectus Deformity: Results of the Ravitch Approach in the Current Era. Ann Thorac Surg 2004; 78: 421-26.[Crossref][PubMed]
  • Schier F, Bahr M, Klobe E: The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg 2005; 40: 496-500.[PubMed][Crossref]
  • Haecker FM, Mayr J: The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction? Eur J Cardiothorac Surg 2006; 29: 557-61.[Crossref][PubMed]
  • Fonkalsrud EW: Management of pectus chest deformities in female patients. Am J Surg 2004; 187: 192-97.[PubMed][Crossref]
  • Onishi K, Maruyama Y: Correction of pectus excavatum using a sternal elevator: preliminary report. Br J Plast Surg 2001; 54: 117-24.
  • Karagounis VA, Wasnick J, Gold JP: An Innovative Single-Stage Repair of Severe Asymmetric Pectus Excavatum Defects Using Substernal Mesh Bands. Ann Thorac Surg 2004; 78: 19-21.[Crossref]
  • Lansman S, Serlo W, Linna O i wsp.: Treatment of Pectus Excavatum with bioabsorbable polylactide plates: preliminary results. J Pediatr Surg 2002; 37: 1281-86.[Crossref]
  • Hernandez H, Varela A, Cordoba M et al.: Videothoracoscopic extrapleureal insertion of Walter Lorenz Surgical bar for pectus excavatum. JTCS 2003; 126: 2081-82.
  • Leonhardt J, Kubler JF, Feiter J et al.: Complications of the minimally invasive repair of pectus excavatum. J Pediatr Surg 2005; 40: E7-E9.[WoS][Crossref]
  • Hendrickson RJ, Bensard DD, Janik JS et al.: Efficacy of left thoracoscopy and blunt mediastinal dissection during the Nuss procedure for pectus excavatum. J Pediatr Surg 2005; 40: 312-14.
  • Zallen GS, Glick PL: Miniature Access Pectus Excavatum Repair: Lessons We Have Learned. J Pediatr Surg 2004; 39: 685-89.[PubMed][Crossref]
  • Ong CCP, Choo K, Morreau P et al.: The learning curve in learning the curve: a review of Nuss procedure in teenagers. ANZ J. Surg 2005; 75: 421-24.[Crossref]
  • Zganjer M, Zupancic B, Popovic L: A 5-year experience of a minimalny invasive technique for correction of pectus excavatum in Croatia. Acta Med (Hradec Kralove) 2006; 5: 105-07.
  • Wu PC, Knauer EM, McGowan GE et al.: Repair of Pectus Excavatum Deformities in Children. A New Perspective of Treatment Using Minimal Access Surgical Technique. Arch Surg 2001; 136: 419-24.[Crossref]
  • Moss RL, Albanese CT, Reynolds M: Major Complications After Minimally Invasive Repair of Pectus Excavatum: Case Reports. J Pediatr Surg 2001; 36: 155-58.[WoS][Crossref][PubMed]
  • Adam KA, Lawrence JL, Meehan JJ: Erosin of the Nuss bar into the internal mammary artery 4 months after minimally invasive repair of pectus excavatum. J Pediatr Surg 2008; 43: 394-397.[Crossref][WoS]
  • Nuss D, Croitoru DP, Kelly RE et al.: Review and Discussion of the Complications of Minimally Invasive Pectus Excavatum Repair. Eur J Pediatr Surg 2002; 12: 230-34.[Crossref]
  • Muensterer OJ, Schenk DS, Praun M et al.: Postpericardiotomy Syndrome after Minimally Invasive Pectus Excavatum Repair Unresponsive to Nonsteroidal Anti-Inflammatory Treatment. Eur J Pediatr Surg 2003; 13: 206-08.
  • Park HJ, Lee SY, Lee HcS. et al.: Complications Associated With the Nuss Procedure: Analysis of Risk Factors and Suggested Measures for Prevention of Complications. J Pediatr Surg 2004; 39: 391-95.[Crossref][PubMed]
  • Van Renterghem KM, Bismarck S, Bax NMA et al.: Should an infected Nuss bar be removed? J Pediatr Surg 2005; 40: 670-73.[Crossref]
  • Barakat MJ, Morgan JA: Haemopericardium causing cardiac tamponade: a late complication of pectus excavatum repair. Heart 2004; 90: e22.[PubMed][Crossref]
  • Watanabe A, Watanabe T, Obama T et al.: The Use of a Lateran Stabilizer Increases bthe Incidence of Wound Trouble Following the Nuss Procedure. Ann Thorac Surg 2004; 77: 296-300.[Crossref]
  • Uemura S, Nakagawa Y, Yoshida A et al.: Experience In 100 cases with the Nuss procedure Using a technique for stabilisation of the pectus bar. Pediatr Surg Int 2003; 19: 186-89.
  • Horch RE, Stoelben E, Carbon R et al.: Pectus Excavatum Breast and Chest Deformity: Indications for Aesthetic Plastic Surgery Versus Thoracic Surgery in a Multicenter Experience. Aesth Plast Surg 2006; 30: 403-11.[Crossref]
  • Kim DH, Hwang JJ, Lee MK et al.: Analysis of the Nuss Procedure for Pectus Excavatum in Different Age Groups. Ann Thorac Surg 2005; 80: 1073-77.[Crossref]
  • Jo WM, Choi YH, Sohn Y et al.: Surgical Treatment for Pectus Excavatum. J.Korean Med Sci 2003; 18: 360-64.
  • Teh SH, Hanna AM, Pham TH et al.: Minimally Invasive Repair for Pectus Excavatum in Adults. Ann Thorac Surg 2008; 85: 1914-18.[Crossref][WoS]
  • Ohno K, Morotomi Y, Ueda M et al.: Comparison of the Nuss Procedure for Pectus Excavatum by Age and Uncommon Complications. Osaka City Med 2003; 49: 71-76.
  • Lawson ML, Mellins RB, Tabangin M et al.: Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg 2005; 40: 174-80.[Crossref]
  • Goretsky MJ, Kelly RE, Croitoru D et al.: Chest wall anomalies: pectus excavatum and pectus carinatum. Adolescent Medicine Clinics 2004; 15: 455-71.[Crossref]
  • Park HJ, Lee SY, Lee ChS. et al.: The Nuss Procedure for Pectus Excavatum: Evolution of Techniques and Early Results on 322 Patients. Ann Thorac Surg 2004; 77: 289-95.[Crossref][PubMed]
  • Cartoski MJ, Nuss D, Goretsky MJ et al.: Classification of the dysmorphology of pectus excavatum. J Pediatr Surg 2006; 41: 1573-81.[Crossref]
  • Izwaryn U, Kuroś-Wikło A: Obustronna analgezja doopłucnowa z zastosowaniem 0,375% bupiwakainy jako rutynowy sposób postępowania po operacjach lejkowatej klatki piersiowej metodą Nussa u dzieci. Przegl Chir Dziecięcej 2006; 1: 145-52.

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