title: Nuss procedure for pectus excavatum in adults: long-term results in a prospective observational study.
abstract: OBJECTIVE
  Since the end of the 1990s, the management of pectus excavatum has undergone major changes. The Nuss procedure (pectus bar) has been the method of choice for patients with pectus excavatum at Bern University Hospital for over a decade. The current study will describe our experiences, with a particular focus on long-term results in adults.
  
  
  METHODS
  The prospective observational study began in autumn 2002. The Haller index was used to quantify pectus excavatum severity. Pulmonary function tests and cardiac examinations were performed preoperatively, and a standardized management for surgical techniques and for the pre- and postoperative treatments including long-term follow-up at 3, 12 and 36 months after surgery was developed. Quality of life and satisfaction with the cosmetic result after the Nuss procedure were evaluated.
  
  
  RESULTS
  Better or much better quality of life after the Nuss procedure was observed: n = 108 (88.4%) at 3 months, n = 97 (89.0%) at 12 months and n = 87 (92.5%) at 36 months. Pain intensity decreased in the follow-up [pain score visual analogue scale (VAS) at 3 months: median 1 (0-7), 12 months: median 1 (0-4), 36 months: median 0.8 (0-5)]. After long-term observation, over 90% of patients described their quality of life after the operation as being better or much better. Satisfaction with the cosmetic results of the operation was also very high, with >90% of patients being satisfied. Only a very small group of patients suffered from pain in the long-term follow-up. Complications were rare (14.7%) and could be treated in most cases without reoperation.
  
  
  CONCLUSIONS
  Our results demonstrate that the Nuss procedure is safe and can be performed with excellent results in adults, both in the short term and in the long term. The improved quality of life and patients' satisfaction with cosmetic results remained high in the long-term follow-up, 10 years after the surgical procedure.
authors.affiliation: Division of General Thoracic Surgery, University Hospital Bern, Bern, Switzerland beatrix.hoksch@insel.ch hoksch@gmx.de.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Hoksch
authors.affiliation: Division of General Thoracic Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Gregor
authors.initials: G
authors.lastname: Kocher
authors.affiliation: Division of General Thoracic Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vollmar
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.affiliation: Division of General Thoracic Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Ralph Alexander
authors.initials: RA
authors.lastname: Schmid
mesh_terms: D000293:Adolescent; D000328:Adult; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D005660:Funnel Chest / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000534:rehabilitation; D009984:Orthopedic Fixation Devices; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011475:Prosthesis Failure; D011788:Quality of Life; D011859:Radiography; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult
keywords: MIRPE; Nuss procedure; Pectus Bar; Pectus excavatum