Objective

To review the surgical experience with the minimal access Nuss procedure in the treatment of pectus excavatum chest deformities at the University Hospital Southampton – UK during a 10-year period. The deformity is a relatively common malformation that is often symptomatic; however, psychological trauma seems the main indication in a growing youngster. The Nuss Procedure is gaining acceptance rapidly as the preferred method for pectus excavatum repair.

Methods

Hospital records from 80 patients who underwent repair of pectus excavatum deformities between 2005 and 2015 were reviewed. Patients under 13 years were excluded. CT scans were not performed routinely and the Haller index was not a criteria for inclusion. Severity was judged by eye-balling the patient. All patients were psychologically affected by the deformity and that was sufficient to offer them the Nuss repair.

Results

There were no deaths. 66 were boys, mean age 17.4 range 5-32 years. The mean hospital stay was 4.6 days (range 2-30 days), with a mean follow-up of 31.8 mo (range 1- 90 mo). 70 bars were removed so far, scheduled in (60) and early in (10), reasons being severe pain, early rotation, sepsis and unacceptable cosmetic results. 56 (70%) had a very good or excellent result, and 14 (17.5%) were totally dissatisfied, two undergoing Ravitch as a second procedure and one opted for a redo-Nuss successfully.

Conclusion

Pectus excavatum deformities can be corrected with a low rate of complications, a short hospital stay, and excellent long- term psychological and cosmetic results using the Nuss technique. The technique is most suitable in symmetrical moderate to severe deformity. Rib flaring might worsen with this type of repair. There is a learning curve and clinicians should be aware of serious and life-threatening complications.