Original article
General thoracic
Routine Use of Minimally Invasive Surgery for Pectus Excavatum in Adults

Presented at the Poster Session of the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.
https://doi.org/10.1016/j.athoracsur.2008.04.078Get rights and content

Background

The Nuss operation, a minimally invasive repair of pectus excavatum, is considered the treatment of choice in children. It is controversial in adults, but smaller series have been published. We have used the Nuss operation routinely in adults since 2003.

Methods

The indication for operation was a patient-described disabling cosmetic appearance. We modified the operation by using a shorter pectus bar, which appears to be more stable. All patient records were available and analyzed retrospectively.

Results

Operations for pectus excavatum were done in 475 patients (89% men) at Aarhus University Hospital. 180 patients (38%) were aged 18 years or older, median patient age was 22 years (range, 18 to 43 years). All but one patient achieved an excellent cosmetic result. Two pectus bars were required in 57 patients (32%), and 2 patients required 3 pectus bars. The median duration of the procedure was 41 minutes (range, 16 to 119 minutes), which was significantly longer compared with younger patients, but the difference was not clinically relevant (6 minutes). Pneumothorax occurred in 86 patients (48%), but only 4 (2%) required chest tube drainage. In 3 patients the pectus bar dislocated during follow-up.

Conclusions

Minimally invasive repair for pectus excavatum can be performed safely in adults, with excellent immediate cosmetic results. Adults often require more than 1 pectus bar. From the results of this large series, we conclude that patients aged younger than 50 years are eligible for minimally invasive surgical correction of pectus excavatum.

Section snippets

Material and Methods

From 2001 to 2007, 475 patients underwent minimally invasive repair of pectus excavatum at Aarhus University Hospital. We began to use this technique in adults in 2003 and have operated on 180 patients who were aged 18 years or older, which is 38% of all our patients. The indication for operation was disabling cosmetic appearance, as described by the patient (Fig 1).

All patients were seen preoperatively for a clinical examination. If the pectus excavatum was evaluated to be less than 2.5 cm

Results

The median age of the 180 patients was 22 years (range, 18 to 43 years), and 160 (89%) were men. No operative deaths occurred. All but one patient achieved an excellent cosmetic result (Fig 6). Two pectus bars were required in 57 patients (32%), and 2 patients required 3 pectus bars. The use of several pectus bars was significantly more common (p < 0.01) in adults compared with younger patients, where 254 patients (86%) received 1 pectus bar and 41 patients (14%) needed 2 pectus bars.

The median

Comment

In 1998 Nuss and colleagues [1] introduced a minimally invasive alternative to the standard open Ravitch technique for the correction of pectus excavatum. The rationale was that it seemed unnecessary to perform an extensive and radical resection when the malleability of the thoracic cage was well demonstrated clinically by the observation that a characteristic “barrel chest” develops even in adult patients with chronic obstructive pulmonary disease long after their bones have matured and

References (29)

Cited by (69)

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    In the adult chest wall, the weight and rigidity of the chest significantly increase the pressure applied to the intrathoracic bars. Two or more Nuss bars distribute the pressure and should be considered in adult patients.4,6,8,59–62 The use of multiple bars also helps to decrease the risk of bar rotation and malposition.4,59,60

  • Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum

    2018, Annals of Thoracic Surgery
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    None of the 8 other patients have reported recurrences. Repair of PE in adults can be more difficult and is associated with a greater number of complications and a higher incidence of repair failures [6–14]. Most literature about failed MIRPE procedures or recurrent PE has reported malpositioned or displaced bars as the most common causes [17, 18, 28].

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    In over 40% of our adult patients, 3 bars were required for complete correction. Others have reported decreased risk of migration and reoperation when multiple bars were inserted [18, 34–36]. In a study of PE repair in 44 late adolescent and adult patients, 11.5% of those with single-bar repairs required reoperation for bar rotation or incomplete correction compared with none of those who had a double-bar repair [37].

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