title: New Berlin-Buch "reversed Nuss," endoscopic pectus carinatum repair using eight-hole stabilizers, submuscular CO2, and presternal Nuss bar compression: first results in 35 patients.
abstract: BACKGROUND
  Since 2001 we minimized access (2.9-4.7 cm) for universally applicable endoscopic hybrid carinatum technique with two transsternal Willital bars in 173 endoscopic hybrid (EH) patients with very satisfactory results. In 2008-2009, endoscopic Nuss bar compression with endoscopic repair of costal flaring applied a new eight-hole stabilizer, which allows the use in pectus carinatum (PC) beyond adolescence including redos and combined deformities. This prospective study of 35 "endoscopic Berlin-Buch reversed Nuss" repairs intends to establish indications for this improved technique.
  
  
  METHODS
  In February 2008 to February 2010, we used endoscopic Nuss bar compression by applying a bilateral new eight-hole stabilizer fixed to the bar without screws or wires, which allows unprecedented versatility and the use in pectus carinatum beyond adolescence. Thirty-five patients aged 17.05 ± 10.2 years (range: 11.3-33.1 years) were recorded prospectively and followed at 3 monthly intervals. We implanted a standard Nuss bar (11-14') into an endoscopically dissected submuscular presternal pocket correcting PC by sternal pressure. The bars were put under tension by traction via bilateral eight-hole stabilizers and three pericostal wire sutures on each side. Bars were removed after 2 years.
  
  
  RESULTS
  All 35 "reversed Nuss" pectus carinatum repairs, including 2 redos after Ravitch, were successful, with no conversion. So far there was no local or general complication and no seroma or bar dislocation. Thirty-one patients judged their result as excellent and 4 as good.
  
  
  CONCLUSIONS
  Although this is a very early experience, "reversed Nuss" is safe and effective and new technical improvements have expanded the range of applicability to older patients and suitable redos.
authors: Helios Center for Pediatric and Adolescent Surgery, Berlin-Buch, Berlin, Germany. klaus.schaarschmidt@helios-kliniken.de
authors: Klaus
authors: K
authors: Schaarschmidt
authors: Michael
authors: M
authors: Lempe-Sellin
authors: Frank
authors: F
authors: Schlesinger
authors: Uwe
authors: U
authors: Jaeschke
authors: Susanne
authors: S
authors: Polleichtner
mesh_terms: D000293:Adolescent; D000328:Adult; D001848:Bone Diseases, Developmental / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019736:Prostheses and Implants; D013906:Thoracoscopy; D016896:Treatment Outcome; D055815:Young Adult