Nuss procedure in pectus excavatum deformity

Objective:Pectus excavatum is the most common congenital chest wall deformity. Rate isapproximately 1/400. It is more common in male-female ratio of 3/1. These patients aregenerally asymptomatic. Patients, generally apply to hospital with psychsocialinconvenience because of chest deformity and that is the major indication for operation.Previously, the deformity was being corrected by sternoplasty with wedge osteotomy andcartilage rib resection said Ravitch procedure. Pectus repair has a new viewpoint bydescription of the minimally invasive procedure by Dr. Nuss in 1986. This procedure hasbecome widespread and has gained an acceptance by the surgeons with fewer incision,shorter hospital stay, less hemorrhage and avoidance of cartilage resection. In this study,demographical properties, complainings, family history, presence of the concomitantpatologies, efficiency of the procedure in correction of deformity, confidence of theprocedure and complications have been examined and presented accmpanied withliterature.Materials and Methods: Prospectively kept records of 29 patients that have beenunderwent pectus excavatum repair by Nuss procedure between 2006 and 2011 in ourclinic were examined. Sex, age, symptoms, family history, presence of the concomitantpatologies, preoperative electrocardiyogram and echocardiogram findings, preoperativeand postoperative pectus index, FEV1 and FVC values in preoperative and postoperativespirometry of the patients, kind of the stabilizer, size of the bar, presence of postoperativecomplication, hospital stay, time of metal bar stay in, occurance of re-depression after barremoval were assessed and parameters recorded in SPSS 16.0 statistic program. Frequencyand descriptives of datas were given. In the evaluation, Wilcoxon Signed Ranks test andSpearman?s correlation test were used in non-parametric tests.Results: Three (%10.3) of all cases were female, 26 (%89.7)were male and mean age was17(7-31). Family history was positive at 13 (%44.8) of cases. There were cardiac patholgyin 10 (%34.4) cases at echocardiography examination. There were scoliosis at 8 (%27.6)cases. Preoperative mean pectus index was 4.19±0.97, postoperative mean pectus indexwas 2.38±0.46. Preoperative mean FVC value was 3.66±0.89 L, FEV1 value was43.52±0.84 L. Postoperativef mean FVC value 3.91±0.86 L, FEV1 value was 3.75±0.83 L.Absorbabl stabilizers used at 5 (%17.2) and metal stabilizers used at 24 (%82.8) of ourcases. Thirteen inches metal bar used at 6 (%20.7) cases, 12 inches at 2(%6.9), 11 inches at9 (%31), 10 inches at 7 (%24.1), 9 inches at 3 ( %10.3) and 8 inches at 2 (%6.9) of cases.Five of theese were long, 24 were short. Postoperative hospital stay were between 1-3days. There were no mortality.Coclusions: Nuss procedure is an effective, safe and minimally invasive method forcorrection of pektus excavatum deformity.