Complications of the Nuss Procedure

Abstract

Purpose: In this paper, we review complications with the Nuss procedure. Materials and Methods: In the last six years 24 cases with a mean age of 8.9 years, 18 males and 6 females, underwent the Nuss procedure for pectus excavatum from March 2001 to March 2007. Twenty-three cases had one bar inserted and only one case had two bars. The pectus bar was fixed to the rib in 8 cases using only stainless-steel wires, with a unilateral stabilizer in 4 cases, and with bilateral stabilizers in the remaining 12 cases. The bar was removed in 15 cases three years after the initial surgery. Results: Early complications: Eight cases showed atelectasis and 4 cases showed subcutaneous emphysema, one case showed pleural effusion, and one case showed pneumothorax with spontaneous resolution. In one case the pectus bar was removed after surgery, because of a bar infection. Bar displacement was seen in one patient, who underwent a subsequent surgery. Late complications: Bar displacement was seen in one case. Three cases showed asymmetrical elevation of the sternum with spontaneous recovery. Retraction of the sternum was seen in one. The displacement of the pectus bar was not seen in any of the recent 12 cases with bilateral stabilizations. Discussion and Conclusions: The displacement of the pectus bar is one of the major complications of the Nuss procedure. Bilateral stabilizers may prevent bar displacement. Infection caused by the bar is another major complication. If conservative therapy is unsuccessful, bar removal should be considered.