title: Modified Nuss procedure in the treatment of recurrent pectus excavatum after open repair.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy of the modified Nuss procedure with a subxiphoid incision in correcting recurrent pectus excavatum.
  
  
  METHODS
  From August 2006 to July 2010, 28 patients with recurrent pectus excavatum underwent a secondary repair using the modified Nuss procedure with a subxiphoid incision and bilateral thoracoscopy. Data concerning symptoms, operative course, complications, pulmonary function and early outcome were recorded.
  
  
  RESULTS
  Prior repairs of the reoperation patients included 16 Ravitch, 9 modified Ravitch and 3 sterno-turnover procedures. The median Haller index was 4.52 for the redo patients. Presenting symptoms included decreased endurance, dyspnoea on exertion, chest pain, frequent respiratory infections and palpitations. The median duration of reoperation was slightly longer than that of the primary surgeries. Blood loss and postoperative hospitalization were similar between groups. Complications from pectus reoperations included pneumothorax, pleural effusion, postoperative pain and wound infection in the lateral incision. There were no perioperative deaths or cardiac perforations. Initial postoperative results varied from excellent to good. The patients were followed up for 24-74 months. No steel bar malposition or stabilizer displacement was found in any case.
  
  
  CONCLUSIONS
  The modified Nuss procedure with subxiphoid incision and bilateral thoracoscopy can avoid cardiac injury to the greatest degree. It would be a minimally invasive and safe approach for patients with recurrent pectus excavatum after failed open repair.
authors: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors: Liang
authors: L
authors: Guo
authors: Ju
authors: J
authors: Mei
authors: Fangbao
authors: F
authors: Ding
authors: Fuxian
authors: F
authors: Zhang
authors: Guoqing
authors: G
authors: Li
authors: Xiao
authors: X
authors: Xie
authors: Fengqing
authors: F
authors: Hu
authors: Haibo
authors: H
authors: Xiao
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008168:Lung / Q000503:physiopathology; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Minimally invasive; Nuss procedure; Pectus excavatum; Recurrence; Reoperation
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