20-Year Jubilee of the Nuss Procedure: A New Era in Treating Thoracic Wall Deformities has been Heralded

The starting point was established by Donald Nuss back in 1998 when he published the insights he had gained through his 10 years' experience of the minimally invasive procedure for correcting pectus excavatum in children. His ingenious attempt to treat this particular index disease has changed the view on thoracic deformities in pediatric surgery and beyond.

Today, the so-called Nuss procedure has become the gold standard for pectus repair. However, much more research has been performed over the course of the past 20 years, and the community has learned a lot. The preferable timing of the Nuss procedure has shifted from childhood to adolescence and early adulthood, and a change in paradigm in terms of the indications has been observed. However, Donald Nuss' innovation was the source of the initial impetus for new ideas on how other deformities of the thorax can be corrected. From the Abramson technique, which is essentially an inverted Nuss procedure, to the revival of braces for pectus carinatum, many new ideas have arisen. And, in the course of these developments, the borders between pediatric and thoracic surgery have been crossed, opening a new field of interdisciplinary cooperation.

As a result of this evolution, the “Chest Wall International Group” was founded 10 years ago and consists of pediatric, thoracic, and plastic surgeons together with experts from other disciplines who are interested in this fascinating topic (www.chestwall.org). Twenty years after the first paper was published by Donald Nuss, we want to look back on the developments and achievements in this domain and present an outlook on how this field is likely to progress over the course of the next decade.

In first place, Dr. Robert Kelly, who succeeded Dr. Donald Nuss in his position at Norfolk Children's Hospital, takes the role as the guardian of the original Nuss procedure and he reflects about modifications and further developments of Donald Nuss' ingenious idea. As a partner from the early onset, Dr. André Hebra highlights the issue of complications, and outlines policies and strategies for prevention. A crucial and still ongoing discussion focuses on timing and indication for surgery in thoracic wall deformities. In this context, Dr. Dawn Jaroszewski provides an update about research on cardiopulmonary function in these patients and Dr. Caroline Fortmann emphasizes the importance of the patients' compromised self-esteem. Dr. Frank-Martin Häcker discusses nonsurgical procedures in general, while Dr. Sherif Emil goes into details about surgery versus bracing in pectus carinatum. And last but not least, Dr. Anton Schwabegger looks at deformities of the chest wall from the plastic surgeon's point of view.

In this sense, these articles from renowned experts in this field mirror the thematic diversity of chest wall deformities in pediatric patients and might provide a fresh impetus to further research and development for their benefit.