Abstract
Purpose Several surgeons have documented outcomes following the Nuss operation. Most reports
have described the use of thoracoscopy to avoid cardiac injury. Since 1999, our group
has utilized a subxiphoid incision, allowing insertion of the surgeon's finger into
the substernal space to help guide the bar across the mediastinum. Our initial experience
has been reported and we are now reporting our entire experience to date.
Methods A retrospective review was conducted on all patients who underwent pectus excavatum
repair using a subxiphoid incision from December, 1999 to September, 2015.
Results During the study period, 554 repairs were performed. A total of 80% of the patients
were male. The mean age was 14.3 years ± 3.1, the mean operating time was 52 minutes ± 17.4,
the mean length of stay was 4.2 days ± 1.1, and the mean time to bar removal was 2.7
years ± 0.7. A total of 20 patients (3.6%) received two bars. No patients sustained
cardiac injury or evidence of pericarditis. Postoperatively, 22 patients (4%) developed
an infection, either cellulitis or a local abscess requiring incision and drainage
and/or antibiotics. In four of these 22 patients, the wound infection developed after
the bar had been removed. Only one patient required bar removal before 2 years due
to an infection. A total of 12 patients required either repositioning of the bar due
to rotation (4) or removal of a stabilizer due to chronic discomfort (8), 2 required
early bar removal for chronic pain, and 1 patient developed a tension pneumothorax
in the operating room. A recurrence has developed in two patients but neither patient
has desired correction.
Conclusion In this relatively large series of patients, the addition of a subxiphoid incision
to the technique has allowed for safe passage of the bar across the mediastinum to
avoid cardiac injury during the Nuss operation.
Keywords
pectus excavatum - Nuss operation - subxiphoid
