title: Complications associated with the Nuss procedure: continued evolution of the learning curve.
abstract: BACKGROUND
  We report unusual and/or significant complications encountered during and after the Nuss Procedure for pectus excavatum.
  
  
  METHODS
  This was a retrospective review that was approved by the institutional review board, with parental consent.
  
  
  RESULTS
  Seven patients had unique and/or significant complications as follows: (1) laceration of an internal mammary artery during bar placement requiring emergent minithoracotomy; (2) hemopericardium 10 weeks postoperatively after blunt chest trauma requiring exploration of the pericardium and clot evacuation; (3) almost complete recurrence of the pectus excavatum deformity immediately after bar removal; (4 and 5) immediate/early postoperative bar displacement requiring re-operation and placement of 2 bars each; and (6 and 7) almost complete neo-ossification of the Nuss bar, making removal challenging.
  
  
  CONCLUSIONS
  The Nuss procedure has met with near-universal acceptance. Complications are just being reported. We describe 7 events to add to the evolving literature as the entire pediatric surgery community participates in the initial learning curve.
authors.affiliation: Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors.forename: Ravindra K
authors.initials: RK
authors.lastname: Vegunta
authors.forename: Paul E
authors.initials: PE
authors.lastname: Pacheco
authors.forename: Lizabeth J
authors.initials: LJ
authors.lastname: Wallace
authors.forename: Richard H
authors.initials: RH
authors.lastname: Pearl
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D013906:Thoracoscopy