title: Nuss procedure: pediatric surgical solution for adults with pectus excavatum.
abstract: BACKGROUND
  The aim of the study was to compare results of the Nuss procedure in adults and children.
  
  
  METHODS
  The data were collected prospectively. Antibiotic prophylaxis was used in all patients. Differences were tested statistically.
  
  
  RESULTS
  A total of 35 adults (28 men; male/female ratio 4:1) with a median age of 23 years (range 18 years to 47 years 1 month) were included in the study. A previous Welch operation had been performed in one (3%). The median operating time was 65 minutes (range 45-105 minutes). Two bars were inserted in one patient, and stabilizers were used in all. Pneumothorax occurred in 9 (26%), wound abscess in 3 (9%), and bar slips in 5 (14%). The median hospital stay was 7 days (range 4-10 days). Bars were removed in 14 (40%) patients without complications. Follow-up occurred 6 and 12 months after bar removed, at which times no recurrence of the pectus and no sternal protrusions were seen. In the other part of the study, 141 children and adolescents (105 boys; male/female ratio 3:1) with a median age of 13 years (range 4 years 11 months to 17 years 8 months) were included. A previous Welch operation had been performed in five (4%). Two bars were inserted in four, and stabilizers were used in 100 (71%). The median operating time was 65 minutes (40-185 minutes). Pneumothorax occurred in 33 (24%), wound abscess in 1 (0.7%), and bar slips in 18 (13%). The median hospital stay was 7 days (range 5-18 days). Bars were removed in 77 (55%) without complications. Follow-up occurred 6 and 12 months after bar removed, and the last follow-up was eventually planned at the end of growth (age 18). The pectus recurred in one patient with Marfan syndrome, and sternal protrusion occurred in one. Differences between groups were as follows: a significantly higher proportion of adult patients were treated with stabilizers (P < 0.001), and there were significantly more wound abscesses in adults (P < 0.001).
  
  
  CONCLUSIONS
  The Nuss procedure is as effective for correcting pectus excavatum in adults as it is in children. However, in adults the bars tended to be less stable, and wound abscesses occurred more frequently.
authors.affiliation: Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC, Academic Medical Center, PO Box 22700, 1100 DE, Amsterdam, The Netherlands. d.c.aronson@amc.uva.nl
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Aronson
authors.forename: Remko P
authors.initials: RP
authors.lastname: Bosgraaf
authors.forename: Chantal
authors.initials: C
authors.lastname: van der Horst
authors.forename: Seine
authors.initials: S
authors.lastname: Ekkelkamp
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome