title: Extrapleural, submuscular bars placed by bilateral thoracoscopy--a new improvement in modified Nuss funnel chest repair.
abstract: BACKGROUND
  Thoracoscopic Nuss funnel chest repair still has a significant complication rate. Bar dislocation, pneumothorax, pleural effusions, and pericarditis seem to be caused mechanical irritation by the bar. We intended to reduce these problems by further technical modification of the Nuss technique.
  
  
  METHODS
  Of 157 prospectively followed modified Nuss repairs, the last 57 patients had the bars placed in an extrapleural position and fixed by 10 to 14 pericostal sutures under bilateral thoracoscopy.
  
  
  RESULTS
  Entirely, extrapleural bar position was feasible in 53 of 57 patients. Four patients had minor holes over one of the bars, predominantly on the left side of the thorax. Pleural effusions, pneumothorax, and pain were greatly reduced, so that we discontinued the so far routine use of bilateral pleural drainages.
  
  
  CONCLUSIONS
  Extrapleural bar position is feasible in more than 90% of modified Nuss repairs. It reduces pleural secretion and pain, and seems to reduce pneumothorax, pulmonary bar adhesions, and pericardial effusions. The technique is easy and safe, and reduced the incidence of most complications in this early experience of 57 adolescent patients, although no sportive restrictions were imposed at all.
authors.affiliation: Helios Center of Pediatric Surgery, Klinikum Berlin-Buch, D-13125, Berlin, Germany. kschaarschmidt@berlin.helios-kliniken.de
authors.forename: Klaus
authors.initials: K
authors.lastname: Schaarschmidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Kolberg-Schwerdt
authors.forename: Michael
authors.initials: M
authors.lastname: Lempe
authors.forename: Frank
authors.initials: F
authors.lastname: Schlesinger
authors.forename: Klaus
authors.initials: K
authors.lastname: Bunke
authors.forename: Jochen
authors.initials: J
authors.lastname: Strauss
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D007839:Functional Laterality; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D013249:Sternum / Q000002:abnormalities; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome