Original articleGeneral thoracicRoutine Use of Minimally Invasive Surgery for Pectus Excavatum in Adults
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
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Complication rates rise with age and Haller index in minimally invasive correction of pectus excavatum: A high-volume, single-center retrospective cohort study
2024, Journal of Thoracic and Cardiovascular SurgeryRisk Factors and Techniques for Safe Pectus Bar Removal in Adults After Modified Nuss Repair
2023, Annals of Thoracic SurgeryNuss procedure in the adult population for correction of pectus excavatum
2018, Seminars in Pediatric SurgeryCitation Excerpt :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
Modifications to the Nuss procedure for pectus excavatum repair: A 20-year review
2018, Seminars in Pediatric SurgeryRevision of Failed Prior Nuss in Adult Patients With Pectus Excavatum
2018, Annals of Thoracic SurgeryCitation Excerpt :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].
Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years)
2016, Annals of Thoracic SurgeryCitation Excerpt :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].