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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 10/2023

14-05-2023 | Original Article

Modification of the Nuss procedure: the crossed bar technique for new subtypes of pectus excavatum

Authors: Nezih Onur Ermerak, Mustafa Yuksel

Published in: General Thoracic and Cardiovascular Surgery | Issue 10/2023

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Abstract

Background

We aim to describe four new subtypes of PE in detail and represent modification of the Nuss procedure called crossed bar technique for their optimum correction with good results.

Methods

101 patients who underwent crossed bar technique between August 2005 and February 2022 were included into the study.

Results

The mean age of the patient series was 21.1 (range 15–38 years) years. Mean Haller index was 3.87. Mean operation duration was 86.84 min. 2 bars were used in 74 (73.3%) of the patients whereas 3 bars were preferred in 27 (26.7%) of them. Mean hospital stay was 4.1 (2–8) days, and all the patients were seen routinely on postoperative follow-up at 1st, 6th, and 18th months. Quality of life questionnaires revealed satisfaction.

Conclusions

Cross bar technique yields satisfactory results for these new subtypes and can be performed safely with good results in these selected group of patients.
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Literature
1.
Robiscek F, Watts LT, Fokin AA. Surgical repair of pectus excavatum and carinatum. Semin Thorac Cardiovasc Surg. 2009;21(1):64–75.CrossRef
2.
3.
Biavati M, Kozlitina J, Alder AC, Foglia R, McColl RW, Peshock RM, Kelly RE Jr, Kim GC. Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape. PLoS ONE. 2020;15(5):e0232575.
4.
5.
Kwiecinski J. Pectus excavatum in mummies from ancient Egypt. Interact Cardiovascul Thoracic Surg. 2016;23(6):993–5.CrossRef
6.
Brochhausen C, Turial S, Müller FKP, Schmitt VH, Coerdt W, Wihlm J-M, Schier F, James Kirkpatrick C. Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovascul Thoracic Surg. 2012;14(6):801–6.CrossRef
7.
Jaroszewski D, Notrica D, McMahon L, Steidley DE, Deschamps C. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23(2):230–9.CrossRefPubMed
8.
Nuss D, Kelly RE Jr, Croitoru DP, Katz ME. A 10 year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatric Surg. 1998;33(4):545–52.CrossRef
9.
10.
Pilegaard H, Licht PB. Minimal invasive repair of pectus excavatum and carinatum. Thorac Surg Clin. 2017;27(2):123–31.CrossRefPubMed
11.
Loos ER, Pennings AJ, van Roozendaal LM, et al. Nuss procedure for pectus excavatum: a comparison of complications between young and adult patients. Ann Thorac Surg. 2021;112(3):905–11.CrossRefPubMed
12.
Tikka T, Kalkat MS, Bishay E, Steyn RS, Rajesh PB, Naidu B. A 20-year review of pectus surgery: an analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg. 2016;23(6):908–13.CrossRefPubMed
13.
Jaroszewski DE, Ewais MM, Lackey JJ, Myers KM, Merritt MV, Stearns JD, Gaitan BD, Craner RC, Gotway MB, Naqvi TZ. Revision of failed, recurrent, or complicated pectus excavatum after Nuss, Ravitch or cardiac surgery. J Vis Surg. 2016;5(2):74.CrossRef
14.
Notrica DM. Modifications to the Nuss procedure for pectus excavatum repair: a 20 year review. Semin Pediatr Surg. 2018;27(3):133–50.CrossRefPubMed
15.
16.
Aizawa T, Togashi S, Domoto T, Sasaki K, Kiyosawa T, Sekido M. Modification of the Nuss procedure: the single-incision technique. Plast Reconstr Surg Glob Open. 2014;2(11):e256.CrossRefPubMedPubMedCentral
17.
Cartoski MJ, Nuss D, Goretsky MJ, Proud VK, Croitoru DP, Gustin T, Mitchell K, Vasser E, Kelly RE Jr. Classification of the dysmorphology of pectus excavatum. J Pediatr Surg. 2006;41(9):1573–81.CrossRefPubMed
18.
Choi JH, Park IK, Kim YT, Kim WS, Kang CH. Classification of pectus excavatum according to objective parameters from chest computed tomography. Ann Thorac Surg. 2016;102(6):1886–91.CrossRefPubMed
19.
Deviggiano A, Carrascosa P, Vallejos J, Bellia-Munzon G, Vina N, Rodríguez-Granillo GA, Martinez-Ferro M. Relationship between cardiac MR compression classification and CT chest wall indexes in patients with pectus excavatum. J Pediatr Surg. 2018;53(11):2294–8.CrossRefPubMed
20.
Park HJ. A technique for complex pectus excavatum repair: the cross-bar technique for grand canyon type deformity (park classification). Annal Cardiothoracic Surg. 2016;5(5):526–7.CrossRef
21.
Darlong LM. Single-centre Indian case series using X or cross bar for Nuss procedure in pectus excavatum. Indian J Thorac Cardiovasc Surg. 2020;36(6):643–8.CrossRefPubMedPubMedCentral
22.
Moon DH, et al. The effectiveness of double-bar correction for pectus excavatum: a comparison between the parallel bar and cross-bar techniques. PLoS ONE. 2020;15(9):e0238539.CrossRefPubMedPubMedCentral
23.
24.
Jaroszewski DE, Ewais MM, Lackey JJ, et al. Revision of failed, recurrent, or complicated pectus excavatum after Nuss, Ravitch or cardiac surgery. J Vis Surg. 2016;2:74.CrossRefPubMedPubMedCentral
25.
Metadata
Title
Modification of the Nuss procedure: the crossed bar technique for new subtypes of pectus excavatum
Authors
Nezih Onur Ermerak
Mustafa Yuksel
Publication date
14-05-2023
Publisher
Springer Nature Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 10/2023
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01940-9

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