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


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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Article: To Nuss or Not to Nuss? Two Opposing Views

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    • "As far as their specific remarks are concerned, I certainly agree with them that the Nuss operation is everything but 'minimally invasive', but question their statements that the open approach requires blood transfusions (none given in our last 500 cases), that it leaves a larger scar (our 'open' procedures are done through a 4–5 cm incisions, which is shorter than the combined length of the 2–6 incisions needed to perform a Nuss), and that the patients after open repair have a longer hospitalization (which, in our present experience, is an average of 32 h) [3] [4] [5] [6]. "

    Preview · Article · Mar 2012 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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    ABSTRACT: Pectus Excavatum is the most common congenital deformity of the chest. Although Pectus Excavatum can be associated with heart or lung problems, the main indication for surgical correction of this congenital anomaly is the body image dissatisfaction. The Nuss technique is a minimally invasive procedure that allows the placement of an intrathoracic prosthetic convex bar, previously bended, which mobilize the sternum anteriorly. The aim of this study was to evaluate the degree of satisfaction of the patients and parents after the application of the Nuss technique using the Pectus Excavatum Evaluation Questionnaire. All parameters of psychosocial character - self-image, difficulties in exposing the chest, frustration, sadness, social isolation and ridicule - found a statistically significant improvement after surgical correction of Pectus Excavatum from the perspective of patients and their parents. There was not a marked improvement and consensus regarding the overall physical performance of patients. Which is understandable, since, theoretically, the physical deformity is not responsible for significant limitations on exertion. The current surgical correction of Pectus Excavatum by the Nuss technique allows obtaining aesthetic results of the chest with the resolution of the main problems with body image. Increase awareness of health issues for psychosocial and physical factors which might be involved in this kind of deformities is important, especially when there is a satisfactory solution.
    Full-text · Article · · Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular
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    ABSTRACT: This review is trying to address the effectiveness and sustainability of results following minimally invasive repair of pectus excavatum (MIRPE). The aim is to present these results for the benefit of clinicians and the patients. Literature search has revealed 179 hits, which were independently assessed and led to 80 publications being formally reviewed. Studies reporting results from less than 10 patients were excluded. Thirty-five studies were found to be reporting results from patients' and/or surgeons' perspective and they were included in this review. Data from the United Kingdom registry for MIRPE were also included. Results from over 2997 patients (age: <1-85 years) who had MIRPE and 1393 patients who had their metallic bar removed were assessed. The most common indication for surgery was cosmesis. There was a net gain with regard to self-esteem for 96-100% of the individuals. A percentage of procedures (0-20%) was assessed by surgeons as having an 'unsatisfactory outcome' and a number of patients (0-25%) reported an 'unsatisfactory end result.' However, these percentages are not necessarily referring to the same patients and an unsatisfactory result does not seem to affect the positive effect on self-esteem. The reported changes in social life, lung capacity, cardiovascular capacity, exercise capacity and general health are based on weak data and significant improvements, if any, are probably seen in a limited number of patients. The metallic bars were removed after 1.5-4.5 years and there is an overall 0-4.5% reported recurrence post-bar removal. In conclusion, MIRPE may improve cosmesis and self-esteem of patients with pectus excavatum deformity. Direct or indirect improvement in other physiological parameters may also help the 'well-being' of these patients and their social integration. There is a clear need for standardisation in the way results are reported in the literature and a socioeconomic analysis with regard to gains, benefits and costs related to MIRPE.
    Preview · Article · Feb 2011 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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