title: The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients.
abstract: BACKGROUND
  The Nuss procedure is a minimally invasive technique using a retrosternal bar to repair pectus excavatum. Although its technical simplicity and cosmetic advantages are remarkable, early applications have been limited to children with symmetrical pectus excavatum. We report a large single-institution experience including technical modifications to correct asymmetric configurations and extend the procedure to adult patients.
  
  
  METHODS
  We retrospectively reviewed 322 consecutive patients who underwent repair of pectus excavatum by the Nuss technique and its modifications between August 1999 and June 2002. Of the patients 251 (78%) were children and 71 (22%) were adults. Precise morphologic characterization of the pectus allowed appropriate shaping of the bar to achieve a symmetric repair.
  
  
  RESULTS
  Of the 322, 185 (57%) had symmetric and 137 (43%) had asymmetric pectus excavatum. Within the asymmetric group 71 were eccentric, 47 were unbalanced, and 19 were combined. Modifications to the shape of the bar including asymmetric and seagull bars were developed to deal with these types of asymmetry. A double bar or compound bar technique was used in most of the adults. Multipoint wire fixations to ribs were utilized to prevent bar rotation. Postoperative complications included pneumothorax (n = 24, 7.5%) and bar displacement (n = 11, 3.4%). The bar was removed in 42 patients 2 years after the initial procedure.
  
  
  CONCLUSIONS
  Precise morphologic classification has led to modifications of the Nuss technique that facilitate correction of virtually all varieties of pectus excavatum including patients with asymmetric varieties and adults.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University, Chunan Hospital, Chunan, South Korea. hyjpark@sch.ac.kr
authors.forename: Hyung Joo
authors.initials: HJ
authors.lastname: Park
authors.forename: Seock Yeol
authors.initials: SY
authors.lastname: Lee
authors.forename: Cheol Sae
authors.initials: CS
authors.lastname: Lee
authors.forename: Wook
authors.initials: W
authors.lastname: Youm
authors.forename: Kihl Roh
authors.initials: KR
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000639:trends