To Nuss or not to Nuss? Two opposing views.

Department of Cardiovascular and Thoracic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Seminars in Thoracic and Cardiovascular Surgery 02/2009; 21(1):85-8. DOI: 10.1053/j.semtcvs.2009.03.007
Source: PubMed

ABSTRACT Although the issue of the appropriate approach for the repair of pectus excavatum remained unsettled for decades, just when we thought that the consensus was clear, an entirely new method was introduced: the Nuss operation. This technique now challenges not only the previously established standards, but also the basic conceptual views of pectus surgery. In the following text, 2 opposing views on the subject are presented: the angle from which Francis Robicsek, a pioneer in conventional pectus excavatum surgery, views the issue, and the opinion of Andre Hebra, who has extensive experience with the Nuss operation.

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    ABSTRACT: Review article related to the management of pectus excavatum. Detailed analysis of the operative treatment of this congenital chest wall malformation. Available at:
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    ABSTRACT: Pectus deformities are the most frequently seen congenital thoracic wall anomalies. The cause of these conditions is thought to be abnormal elongation of the rib cartilages. We here report our clinical experience and the results of a sternochondroplasty procedure based on the subperichondrial resection of the elongated cartilages. This technique is a valuable surgical strategy to treat the wide variety of pectus deformities. During the period from October 2001 through September 2009, 205 adult patients (171 men and 34 women) underwent pectus excavatum (181), carinatum (19) or arcuatum (5) repair. The patients' pre and postoperative data were collected using a computerized database, and the results were assessed with a minimum 2-year follow-up. The postoperative morbidity rate was minimal and the mortality was nil. The surgeon graded cosmetic results as excellent (72.5%), good (25%) or fair (2.5%), while patients reported better results. Patients with pectus excavatum were found to have much more patent foramen ovale (PFO) than the normal adult population, which occluded after the procedure in 61% of patients, and significant improvement was found in exercise cardiopulmonary function and exercise tolerance at the 1-year follow-up. Our sternochondroplasty technique based on the subperichondrial resection of the elongated cartilages allows satisfactory repair of both pectus excavatum and sternal prominence. It is a safe procedure that might improve the effectiveness of surgical therapy in patients with pectus deformities.
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    ABSTRACT: Pectus excavatum, also known as sunken or funnel chest, is a congenital chest wall malformation in which several ribs and the sternum grow abnormally, producing a concave or caved-in appearance of the anterior chest wall and sternum. This article provides a detailed review of the minimally invasive technique for repair of pectus excavatum (MIRPE), also known as the Nuss procedure. Available at: