OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of non-thoracoscopic extrapleural approach of the Nuss procedure for the correction of pectus excavatum in children. METHODS: From October 2007 and January 2009, 42 patients with pectus excavatum were treated in the Tangdu Hospital, Xi'an, China, with surgical correction through the Nuss procedure. Among them, 20 underwent a Nuss procedure with thoracoscopic guidance, and the other 22 patients were treated with non-thoracoscopic extrapleural approach, in which a bilateral extrapleural tunnel to the edge of sternum was created using a blunt dissection through bilateral thoracic skin incisions. Without introducing the thoracoscopy into the thoracic cavity, a steel bar was inserted in the entirely extrapleural tunnel and turned as in the standard Nuss procedure. RESULTS: The operations were completed successfully in all patients treated. The operation time and postoperative hospitalisation time of the non-thoracoscopic extrapleural Nuss group were significantly less than those of the thoracoscopic group (P<0.05). There was no pneumothorax or hydrothorax in our series and no tube thoracostomy was further needed. All patients were followed up for more than 2 months, and the surgical outcomes were excellent. CONCLUSIONS: The non-thoracoscopic extrapleural approach of the Nuss procedure is a safe and less traumatic procedure for the correction of pectus excavatum. Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of non-thoracoscopic extrapleural approach of the Nuss procedure for the correction of pectus excavatum in children. METHODS: From October 2007 and January 2009, 42 patients with pectus excavatum were treated in the Tangdu Hospital, Xi'an, China, with surgical correction through the Nuss procedure. Among them, 20 underwent a Nuss procedure with thoracoscopic guidance, and the other 22 patients were treated with non-thoracoscopic extrapleural approach, in which a bilateral extrapleural tunnel to the edge of sternum was created using a blunt dissection through bilateral thoracic skin incisions. Without introducing the thoracoscopy into the thoracic cavity, a steel bar was inserted in the entirely extrapleural tunnel and turned as in the standard Nuss procedure. RESULTS: The operations were completed successfully in all patients treated. The operation time and postoperative hospitalisation time of the non-thoracoscopic extrapleural Nuss group were significantly less than those of the thoracoscopic group (P<0.05). There was no pneumothorax or hydrothorax in our series and no tube thoracostomy was further needed. All patients were followed up for more than 2 months, and the surgical outcomes were excellent. CONCLUSIONS: The non-thoracoscopic extrapleural approach of the Nuss procedure is a safe and less traumatic procedure for the correction of pectus excavatum. Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.