Minimally invasive repair of pectus excavatum in children: Results of a modified Nuss procedure.
BACKGROUND
Pectus excavatum (PE) is the most common deformity of the anterior thoracic wall. The Nuss technique allows the thorax to be reshaped with the aid of a retrosternal metallic bar. The aim of this study is to evaluate and compare the complication rate between the original Nuss technique and a lightly modified approach.


METHODS
We performed a retrospective single-center observational study based on the medical files of patients operated for PE in the Pediatric Surgery Unit between July 2004 and July 2015. We divided two patient groups according to the operating technique employed: the Nuss group (NG) and the modified Nuss group (MNG) with supplementary subxiphoid incision and bilateral thoracoscopy.


RESULTS
Twenty-seven patients were included: sixteen in the NG and eleven in the MNG. No significant differences were found between the two groups for all kinds of complications: total complication rate (50% for the NG versus 54% for the MNG, P>0.05), early (31% vs 46%, P>0.05), late (19% vs 9%, P>0.05), non-serious (37% vs 36%, P>0.05) or serious (13 vs 18%, P>0.05). There was no life threatening complication in the MNG, contrary to the NG. In the two groups, a significant difference was found (P=0.029) regarding the operating time: longer operating times (80±25min) were correlated with a higher complication rate.


CONCLUSIONS
The modified Nuss technique does not cause more complications than the original technique described by Nuss and it has the advantage to minimize the risk of heart damage.
Unit of paediatric surgery, Strasbourg university hospital, Strasbourg, France. Electronic address: anastasia.durry@chru-strasbourg.fr.
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Durry
Unit of paediatric surgery, Luxembourg, France. Electronic address: gomes.cindy@chl.lu.
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Gomes Ferreira
Unit of paediatric surgery, Strasbourg university hospital, Strasbourg, France. Electronic address: thibault.tricard@chru-strasbourg.fr.
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Tricard
Unit of paediatric surgery, Strasbourg university hospital, Strasbourg, France. Electronic address: philippe.gicquel@chru-strasbourg.fr.
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Gicquel
Unit of paediatric surgery, Strasbourg university hospital, Strasbourg, France. Electronic address: francois.becmeur@chru-strasbourg.fr.
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Becmeur
D000293:Adolescent; D002648:Child; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009984:Orthopedic Fixation Devices; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013249:Sternum / Q000601:surgery*; D013906:Thoracoscopy / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
Children; Complications; Enfants; Heart damage; Lésions cardiaques; Nuss technique; Pectus excavatum; Technique de Nuss