title: Is the grass greener? Early results of the Nuss procedure.
abstract: OBJECTIVE
  Minimal access surgery (MIS, Nuss Procedure) is gaining acceptance rapidly as the preferred method for pectus excavatum repair. This shift in operative management has followed a single institution's evaluation of the procedure. This report describes an additional experience with the Nuss procedure.
  
  
  METHODS
  Twenty-one patients with pectus excavatum underwent repair by the Nuss Procedure. The patients ranged in age from 5 to 15 years (average, 8.2 years). There were 19 boys and 2 girls.
  
  
  RESULTS
  In 1 patient (age 5 years) the MIS procedure was aborted because of persistence of chest wall asymmetry. The other 20 patients had completion of their procedure without intraoperative complication. The operating times ranged from 45 to 90 minutes; however, there was an additional anesthetic set-up time (average, 45 minutes). All cases utilized a single support bar (11 to 17 inches). Patients underwent extubation in the operating room and were admitted to a ward bed with an epidural catheter in place for pain control and received intravenous analgesia. The hospital stay ranged from 4 to 11 days and averaged 4.9 days. Early postoperative complications included ileus (n = 1), bilateral pleural effusion (n = 2), atelectasis (n = 1), fungal dermatitis (n = 1), pneumothorax (n = 1), and flipped pectus bar (n = 2). Delayed complications included flipped pectus bar (n = 2), marked pectus carinatum requiring bar removal (n = 1), mild carinatum (n = 1), mild bar deviation (n = 1), progressive chest wall asymmetry (n = 3) with 1 requiring bar removal and open pectus repair, pleural effusion (n = 1), and chronic persistent pain requiring bar removal (n = 1). The length of follow-up is 3 to 20 months with an average of 12.3 months.
  
  
  CONCLUSIONS
  The Nuss Procedure is quick, minimally invasive, and a technically easy method to learn; however, our data indicate there is a significant learning curve. Although previous reports suggest that few complications occur, we believe further assessment of patient selection regarding age, presence of connective tissue disorder, and severe chest wall asymmetry are still needed. Long-term follow-up also will be required to assure both health professionals and the public that this is the procedure of choice for patients with pectus excavatum.
authors.affiliation: Section of Pediatric Surgery, Indiana University School of Medicine, and the James Whitcomb Riley Hospital for Children, Indianapolis, USA.
authors.forename: S
authors.initials: S
authors.lastname: Engum
authors.forename: F
authors.initials: F
authors.lastname: Rescorla
authors.forename: K
authors.initials: K
authors.lastname: West
authors.forename: T
authors.initials: T
authors.lastname: Rouse
authors.forename: L R
authors.initials: LR
authors.lastname: Scherer
authors.forename: J
authors.initials: J
authors.lastname: Grosfeld
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D011183:Postoperative Complications; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome