title: Previously Complicated Nuss Procedure Does Not Preclude Blind Removal of the Bar.
abstract: BACKGROUND
  Nuss procedure has become the procedure of choice for well-selected patients with pectus excavatum. Perioperative complications may pose difficulty during the subsequent bar removal due to adhesions and tissue plane disruptions during the initial surgery and repair. This report describes bar removal experience in patients whose Nuss procedures were complicated by cardiac injury, pericardial breach, and lung parenchyma/diaphragm injury during the initial procedure.
  
  
  METHODS
  A total of 529 patients who underwent Nuss procedure between 2007 and 2014 were recorded in a prospective database. Twenty patients with complications (cardiac injury [n = 1], pericardial breach [n = 3], and lung parenchyma/diaphragm injury [n = 16]) were identified. All bars were removed via subcutaneous tissue dissection, without intrathoracic visualization.
  
  
  RESULTS
  Average duration of bars was 36 months (±16 months). All bar removal procedures were completed without any need for extra interventions with negligible blood loss. Eighteen patients were able to be discharged within 2 postoperative days.
  
  
  CONCLUSIONS
  Blind bar removal in patients with previously complicated Nuss procedure seems safe and no other interventions (videothoracoscopy, subxiphoid incision, etc.) during bar removal seem to be necessary.
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Marmara University, Istanbul, Pendik, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Bilgi
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Marmara University, Istanbul, Pendik, Turkey.
authors.forename: Nezih Onur
authors.initials: NO
authors.lastname: Ermerak
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Marmara University, Istanbul, Pendik, Turkey.
authors.forename: Tunç
authors.initials: T
authors.lastname: Laçin
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Marmara University, Istanbul, Pendik, Turkey.
authors.forename: Korkut
authors.initials: K
authors.lastname: Bostancı
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Marmara University, Istanbul, Pendik, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yüksel
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004210:Dissection / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D005660:Funnel Chest / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D013249:Sternum / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult