2017 Volume 53 Issue 7 Pages 1242-1246
Purpose: The Nuss procedure became a standard operation procedure for pectus excavatum. However, the optimal age for this operation has not been identified. Hence, in order to determine any long-term changes in the chest of older children, we measured the vertebral index (VI) in patients who underwent bar removal and followed up the patients for 3 years.
Methods: We reviewed the cases of 18 patients (13 boys and 5 girls) whose bar was removed between 10 and 14 years of age. They were followed up for three years after the bar removal. The mean age at primary surgery was 8.3 ± 1.2 (range: 5–10); at removal, the mean age was 11 ± 0.7 (range: 10–12), and the mean period between the initial operation and the bar removal was 30.7 ± 10.7 months. VI was measured from a lateral chest X-ray at 5 time points: before the Nuss procedure, immediately after bar removal, and one year, two years, and three years after bar removal.
Results: The VIs were as follows: before the Nuss procedure, 31.7 ± 7.9; immediately after removal, 23.7 ± 2.9; one year after removal, 23.9 ± 3.2; two years after removal, 25.2 ± 3.8; three years after removal, 24.8 ± 2.9. No statistical difference in VI was observed among the three groups.
Conclusion: In the cases of bar removal between the ages of 10 and 14, there was no evidence of long-term VI change. This means that the recurrence of pectus excavatum is less likely in these cases. It can be proposed that the optimal age for the Nuss procedure is 8 years or higher.
