Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction.

Abstract

BACKGROUND:

Chest wall remodeling by substernal placement of a Nuss bar is the treatment of choice for children with pectus excavatum; however, it has not yet gained widespread acceptance in adults. We demonstrate that thoracoscopic Nuss bar insertion in young adults is safe and leads to excellent results.

METHODS:

Adult patients who underwent thoracoscopic Nuss bar insertion at one institution between 2006 and 2012 were identified. Data on demographics, postoperative outcomes, quality of life, and cosmetic satisfaction was collected. A validated single-step quality of life survey was administered to patients. Student's t test and the Wilcoxon rank sum test were used for statistical analysis.

RESULTS:

Seventy-three patients (65 male, 8 female) with a median age of 20 years (range, 16 to 51) were included. The median follow-up was 44.6 months (range, 36.9 to 73.26). Most patients (59 of 73, 81%) had one bar placed. The median length of hospital stay was 5 days (range, 3 to 9) and the median duration of epidural anesthesia was 3 days (range, 0 to 7). There were 4 reoperations (5.5%) in the immediate postoperative period: 2 for bar displacement and 2 for poor cosmesis. All reoperations were performed thoracoscopically. Other postoperative complications included pneumothorax (3 of 73, 4.1%) and ileus (1 of 73, 1.3%). Fifty-one patients participated in a quality-of-life survey (73% response rate). The mean self-esteem score improved from 4.6 of 10 preoperatively to 6.5 of 10 postoperatively (p=0.002). The social impact of the pectus deformity became less significant (mean preoperative score 3.6, mean postoperative score 2.8, p=0.02). The severity of initial postoperative pain was much improved on follow-up. The vast majority of patients (41 of 51, 80%) were satisfied with the cosmetic result, and 96% (49 of 51) would opt to have the surgery again.

CONCLUSIONS:

For young adults who wish to correct their pectus deformity, a thoracoscopic Nuss procedure is safe and results in a high rate of patient satisfaction, significant improvement in self-image, and excellent midterm cosmetic results.

• Authors: Waël C Hanna, Michael A Ko, Maurice Blitz, Yaron Shargall, Christopher G Compeau
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 96 Issue 3 Pg. 1033-6; discussion 1037-8 (Sep 2013) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 23810179 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Cohort Studies
• Esthetics
• Female
• Follow-Up Studies
• Funnel Chest (diagnosis, surgery)
• Humans
• Male
• Middle Aged
• Patient Safety
• Patient Satisfaction (statistics & numerical data)
• Prostheses and Implants
• Quality of Life
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Statistics, Nonparametric
• Thoracic Surgery, Video-Assisted (instrumentation, methods)
• Treatment Outcome
• Young Adult