Pectus excavatum surgery: sternochondroplasty versus Nuss procedure.
BACKGROUND
The repair of pectus excavatum (PE) by minimally invasive Nuss surgery is well established, but its complication rate is high and its indication is indiscriminate. Sternochondroplasty (SCP) provides good results with a low complication rate but requires a small transverse incision.


METHODS
To compare SCP and Nuss, we analyzed 40 patients with PE who underwent surgery (SCP, n = 20; Nuss, n = 20). Thirty subjects (75.0%) were male and 10 (25.0%) were female. In the SCP group, 9 (45.0%) had symmetric PE, and 11 (55.0%) had asymmetric PE. In the Nuss group, 17 (85%) had symmetric PE, and 3 (15%) had asymmetric PE (p = 0.020).


RESULTS
The mean duration of SCP was 229.5 minutes, and the mean duration of Nuss was 54.3 minutes. The average length of hospital stay was 4 days with SCP and 6.3 days with Nuss (p = 0.172). The SCP results were favorable in 18 subjects (90%) and fair in 2 subjects (10%). In the Nuss group, we observed 17 patients (85.0%) with favorable results and 3 (15.0%) with poor results. Patients with asymmetric PE exhibited severe pectus carinatum. No complications were found in 17 patients (85%) in the SCP group. In the Nuss group, 9 patients (45.0%) had 13 complications (65.0%; p = 0.004).


CONCLUSIONS
Sternochondroplasty surgery yielded better results than the Nuss procedure and more patients with asymmetric PE, less pain, and fewer complications. Nuss surgery had shorter operating times than SCP, younger patients, more symmetric PE, and 3 patients who experienced severe postoperative asymmetric pectus carinatum. In summary, for asymmetric PE the best indication is SCP.
Coelho
Marlos de Souza
Mde S
Thoracic Surgical Department, Hospital Universitário Cajuru, Curitiba, Brazil. clinicadotorax@marloscoelho.com.br
Silva
Ruy Fernando Kuenzer Caetano
RF
Bergonse Neto
Nelson
N
Stori
Wilson de Souza
Wde S
dos Santos
Anna Flávia Ribeiro
AF
Mendes
Rafael Garbelotto
RG
Fernandes
Lucas de Matos
Lde M
D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000601:surgery*; D002648:Child; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D056346:Sternotomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult