Pectus excavatum and nuss minimally invasive technique: 4 years experience in Croatia

The aim of this study was to assess the results of four years experience with the minimally invasive correction of pectum excavatum, which requires no cartilage incision or excision, and no sternal osteotomy. Since 2001 we have performed 55 minimally invasive pectus excavatum procedures at our hospital. A convex steel bar is inserted under the sternum through small bilateral thoracic incisions. The curved steel bar is inserted with the convexity facing posteriorly, and when it is in position, it is turned around 180 degrees. Between 2 and 4 years, when permanent remolding occurs, the bar is removed. Among 55 patients who had the minimally invasive procedure, 18 patients have already had their bar removed. Average blood loss was 25 mL and average length of hospital stay was 10 days. Patients returned to full activity after 2 months. Complications were pneumothorax in 9 patients (only 4 required a thoracostomy tube, the other 5 resolved spontaneously), pneumonia in 3 patients, and bar displacement in 1 patient. The mean follow-up was approximately 3 years after operative treatment. Excellent results were maintained in 45 patients (normal postoperative chest), good results in 8 patients (mild residual pectus) and poor in 2 patients (severe recurrence requiring further treatment ). Poor results occurred because the steel bar was too soft in 1 patient, and the sternum too soft in 1 patient with Marfan s syndrome. Our early results with the minimally invasive technique without cartilage incision and resection or sternal osteotomy showed that the procedure is effective with excellent results.