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J Thorac Cardiovasc Surg 2006;132:524-529
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Minimally invasive correction of pectus excavatum in adult patients

Johannes Schalamon, MD, Stefan Pokall, MD, Jana Windhaber, MD, Michael E. Hoellwarth, MD, Prof*

Department of Pediatric Surgery, Medical University of Graz, Austria

Received for publication December 22, 2005; revisions received March 29, 2006; accepted for publication April 20, 2006.

* Address for reprints: Michael E. Hoellwarth, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria (Email: michael.hoellwarth{at}meduni-graz.at).

OBJECTIVE: The repair of pectus excavatum by minimally invasive surgery (Nuss procedure) is well established among pediatric surgeons. Studies on adult patients are rare. We analyzed the efficacy of minimally invasive pectus repair in a series of adult patients.

METHODS: We prospectively included all adult patients with minimally invasive repair of funnel chest treated from 2000 to 2005. The pectus bar was inserted under thoracoscopic control. On the right side a stabilizer was used to prevent bar displacement. Postoperative pain control was provided by epidural catheters. Clinical checks were performed 2 weeks, 3 months, and then annually after discharge.

RESULTS: Forty-three adult patients (39 men, 4 women) with a mean age of 22 years (range 18-39 years) were included. Mean duration of the operative procedures was 70 minutes (range 29-125 minutes); mean length of hospital stay was 9.3 days. Bars were removed from 15 patients 3 years after implantation. Minor complications occurred in 8 patients (19%), with intrapleural effusions being most frequent (n = 5). Three patients (7%) had major complications: drainage of a pneumothorax (n = 2) and bar displacement (n = 1). The cosmetic results were excellent and patient satisfaction was high.

CONCLUSIONS: We conclude that the Nuss procedure was beneficial in adult patients. Dislocation of the pectus bar can be prevented by submuscular placement. The use of corticosteroids may be helpful in case of repeated, uncontaminated pleural effusions. Patient satisfaction and the acceptable number and kind of complications are encouraging.

Abbreviations and Acronyms NSAID = nonsteroidal anti-inflammatory drug; PDS = polydioxane




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