Minimally Invasive Repair of Pectum Excavatum Using the Nuss Technique in Children and Adolescents: Outcomes, Indications, and Limitations

The Nuss technique for minimally invasive repair of pectus excavatum involves thoracoscopy-assisted insertion of a bar or plate behind the deformity to displace the sternum anteriorly. The malleability of the chest wall during the growth period allows stable correction of the deformity. Several types of complications have been described since the introduction of The Nuss technique. We hypothesised that improved patient selection would clarify the indications and shed light on the limitations of this procedure. Based on a retrospective case-series of 120 children and adolescents, we evaluated the outcomes and patient-selection criteria of this technique. Computed tomography (CT) of the chest was obtained routinely before surgery. None of our patients experienced fatal complications or major cardio-pulmonary complications. In 12 patients, we used a sub- and retro-xiphoid approach to guide implant insertion behind the sternum. Surgery performed for cosmetic purposes in minor patients may raise ethical questions.Earlier data on fatal or major complications indicate a close correlation with a history of cardio-thoracic surgery and with the severity of the deformity.Minimal invasive Nuss technique is an interesting treatment option in children. The risk of major cardio-pulmonary complications can be markedly diminished by using a sub- and retro-xiphoid approach. We believe the main limitations to thoracoscopy-assisted repair are a history of cardio-thoracic surgery and the finding by CT of a sterno vertebral distance lower than 5 cm or of an sternal rotation angle greater than 35°. Finally, marked chest-wall asymmetry contra-indicates endoscopic approach and a better option in this situation is sub-perichondral sterno-chondroplasty at the end of puberty.