The Nuss Procedure: Our Experience from the First Fifty

Purpose: The Nuss procedure for pectus excavatum has rapidly gained acceptance among pediatric surgeons. We present the results and lessons learned from our initial 50 patients undergoing the minimally invasive pectus repair. Patients and methods: After obtaining Internal Review Board approval, we retrospectively reviewed patients undergoing the Nuss procedure from April 1998 to September 2002. Data, including age, operative time, length of hospital stay, and complications, were recorded. Results: Fifty patients whose average age was 13 years underwent the procedure. The mean operative time was 90 minutes, and the average length of stay was 6 days. Eleven immediate postoperative pneumothoraces were detected, none of which required tube thoracostomy or aspiration. One displaced bar was replaced at 6 weeks, and infection necessitated the removal of that bar at 11 months. A second displaced bar lacking a stabilizer was removed at 15 months with a good cosmetic result. Three bar stabilizer complications occurred. One was replaced at 5 weeks because of displacement, and broken stabilizers were replaced and removed in two other cases. A 16-gauge rib wire has replaced the bar stabilizer in the last eight patients. One internal mammary artery injury occurred during bar insertion. To date, 22 bars have been removed, with overall good cosmetic results. Conclusion: Advantages of the Nuss procedure in comparison with the open approach are decreased operative times, minimal blood loss, and improved cosmesis. Unique complications included an infected bar, broken bar stabilizers, and an internal mammary artery injury. Initial results demonstrate that the Nuss procedure is a safe and effective method of pectus excavatum repair.