Comparison of several alternatives for the management of severe pectus excavatum in the Nuss procedure.

Background: The aim of this study was to assess the safety of several modified Nuss procedures for severe pectus excavatum (PE).

Methods: Thirty-four patients with severe PE underwent the Nuss procedure: 10 underwent slanting-directed bar insertion (group A); 11 underwent standard Nuss procedure (group B); and 13 underwent Nuss procedure with subxiphoid assistance (group C). All the patients met the criteria of having a Haller index greater than 4.5, assessed from chest computed tomography. Besides, the transverse length of the most depressed point and the 2-intercostal left slant length between the heart and the anterior chest wall were measured.

Results: All patients were followed up for 6-45 months (mean 31.4 ± 11.38 months). None of the patients suffered from injuries to the pericardium, heart or lungs. There were no significant differences in age, Haller's index, operation time and postoperative stay among the three groups. However, two patients in group B experienced bar rotation and subsequently required reoperation vs the other two groups (p < 0.001). The length of contact between the heart and the chest wall was shorter in the left slant axis (5.8 ± 0.33 cm) than in the transverse axis (7.3 ± 0.37 cm) in group A (p = 0.001).

Conclusion: A modified Nuss procedure of slanting steel bar insertion has shown to be a safe and effective approach for the correction of severe PE.