• Journal of Chest Surgery
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• v.37 no.6
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• pp.536-538
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• 2004

There are still some controversies regarding one stage repair of pectus deformity with congenital heart disease due to probable complications after extensive resection of deformed cartilages. We performed Nuss operation with simul-taneous intracardiac repair in 8 year old patient with pectus excavatum and partial atrioventricular septal defect. The result of operation was satisfactory without prolongation of operation time, bleeding or instability of chest wall.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.868-871
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• 2006

Nuss operation as a method for correction of pectus excavatum is safe and satisfactory, but its complication presents pneumothorax, displaced bar, wound infection, pericarditis, pleural effusion, hemothorax, cardiac injury etc. We report a rare case of acute ascending aortic rupture after displaced and adhered Nuss bar removal. The patient was a 30-years old man who received Nuss operation 3 years ago. Nuss bar was removed without resistance but massively bled at both operation wound, so immediately femoro-femoral CPB and median sternotomy was done and repaired proximal aortic arch under deep hypothermic total circulatory arrest. The patient was discharged without complication at postoperative 13 day.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.765-769
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• 2006

Background: Nuss procedure is a minimally invasive technique for correcting the pectus excavatum. But there are some limitations of correcting the complex anomaly or grown-up patients. Material and Method: we retrospectively reviewed 135 consecutive patients who underwent repair of pectus excavatum by the Nuss procedure and its modifications between November 1999 and December 2004. We analyzed the computed tomography, age on operation, operative technique, and complications. Result: We operated 135 patients of pectus excavatum during 62 months. Total number of operations about Nuss procedure is 216, including bar removal procedure of 64 cases, redo Nuss procedures of 47 cases. We modified the point of bar insertion to the hinge point, made a shoulder in the bar to prevent a displacement. And then we changed the fixation material from Vicryl to steel wire. If the patients are old, we retract the sternum during bar rotation and fixation. Until 2002, the number of redo Nuss operations were 17, complications were 23. but, after modifications, the number of redo Nuss operation were 0, complications were 2. Conclusion: This result indicates that our modifications of Nuss operation is effective, and could decrease the number of redo Nuss operation and complications.

• Journal of Chest Surgery
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• v.45 no.5
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• pp.308-315
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• 2012

Background: Long-term surveillance comparing satisfaction between the early experience of Nuss procedure vs. Ravitch procedure. Materials and Methods: A total of 100 patients that underwent surgical correction of a pectus excavatum between 2001 and 2004 and were followed for ${\geq}2$ years were included. Surveillance on the degree of satisfaction was performed using five-levels of the Likert scale and self-assessment scoring. Results: Nuss or Ravitch surgery was performed in 63 and 37 patients, respectively. The Nuss procedure required a shorter operation time and shorter hospital stay than the Ravitch procedure (p<0.001). The surveillance demonstrated that 17.6% of the Nuss group and 35.7% of the Ravitch group were not satisfied with the outcome of the surgery (p=0.072). The most common causes of dissatisfaction were redepression in the Nuss group (n=5) and incomplete correction in the Ravitch group (n=7). The multivariate analysis showed that reoperation and a high postoperative pectus index were significant risk factors for a low satisfaction score. Conclusion: The Nuss procedure had several advantages over the Ravitch procedure in the immediate postoperative period. However, the long-term satisfaction was determined by a complete correction without recurrence or need for re-intervention rather than by the operation type.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.473-479
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• 2021

Background: The purpose of this study was to compare 1-year clinical outcomes between patients who underwent a Nuss operation or vacuum bell therapy and to present vacuum bell therapy as a possible alternative treatment modality for patients who prefer non-surgical correction of pectus excavatum. Methods: We conducted a retrospective review of pectus excavatum patients who had undergone vacuum bell therapy for more than 1 year and examined patients who had undergone Nuss bar removal more than 1 year previously. The treatment outcomes were evaluated by comparing changes in the Haller index before and after treatment in both patient groups. Results: We included 57 patients in this study and divided them into 2 groups according to the type of treatment received. Both groups showed no significant difference in the post-treatment Haller index after 1 year of follow-up, although the Nuss operation group showed a greater change in the Haller index than the vacuum bell group. Conclusion: Although the Nuss operation is a well-established and effective treatment of choice to correct pectus excavatum, vacuum bell therapy showed comparable outcomes and could become an alternative treatment modality for select patients who prefer non-invasive treatment.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.739-742
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• 2008

Purpose: Breast augmentation is one of the common procedures in plastic surgery today. The shape, size and insertion plane of the implant is decided preoperatively by physical examination of the breast. Pectus excavatum is one of the most common anomalies of chest wall, characterized by a depression of the anterior chest wall. For patients with a mild type of pectus excavatum, the main purpose of the treatment is aesthetic rather than functional improvement. Two most surgical treatment options for skeletal deformity are the Ravitch technique and minimally invasive Nuss repair. Other options for soft tissue repair are implant insertion and autologous soft tissue augmentation. We performed a surgical operation with Nuss procedures and breast augmentation for a patient with mild pectus excavatum and hypoplastic breast. Methods: A 32 year-old female was presented with hypoplastic breast. Preoperative chest CT was performed, showing pectus excavatum. After Nuss procedure, we inserted saline implant(275 cc textured round breast implant, moderate profile) submuscularly to restore adequately projected breast. Results: Patient's postoperative course was uneventful without any complication. After 6 months of follow-up period, the patient had an excellent result, with high patient satisfaction and no complications. Conclusion: For patients with a mild type of pectus excavatum, who do not have cardiopulmonary symptoms and requires for aesthetic improvement, this simple approach with Nuss procedure and breast augmentation achieves excellent aesthetic correction with low complication rate and high patient satisfaction.

• Journal of Chest Surgery
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• v.57 no.3
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• pp.300-301
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• 2024

• The Korean Journal of Pain
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• v.25 no.4
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• pp.267-271
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• 2012

The Nuss procedure for the correction of Pectus Excavatum (PE) is associated with intense postoperative pain. Our strategy to control early postoperative pain is to combine epidural with intravenous analgesia. Our aim was to analyse our pain control strategy by reviewing all the PE cases treated at our institution. Sixty consecutive patients, aged between 12 and 26 years old, received the PE operation at our institution from January, 2007 to September, 2010. The median age was 16 (12-27) with a male/female ratio of about 7/1. An epidural catheter was employed in all the cases, with 38 patients (63%) requiring additional drugs to control pain, which remained in place for 74 hours (72-96). The pain score was higher in male patients, but lower in those younger than 16 years old. Moreover, patients that consumed benzodiazepines had a significant decrease in cumulative opioid intake (P = 0.0408). Both gender and age had an impact on pain control, while we noticed a synergistic effect between opiates and tranquillizers.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.524-529
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• 2004

Background: Since the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. We examined complications in a single-institute experience of the Nuss technique in order to develop possible solutions to prevent them. Material and Method: 335 consecutive patients, who underwent the modified Nuss procedure between August 1999 and October 2002, were studied retrospectively. Median age was 8 years (range 1 to 46). 264 patients (78.8%) were in pediatric group (age$\leq$15) and 71 patients (21.2%) were in adult group (age> 15). 193 patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multi-variate logistic regression. Result: Postoperative complication rates were 18.9% (61/335) in total patients. Frequent complications were pneumothorax 24 (7.5%), bar displacement 11 (3.4%), and wound seroma 10 (3.1%) in order. Early complications (within a month, 49 cases, 15.2%) were pneumothorax (n=23, 6.9%), wound seroma (n=12, 3.6%), and bar displacement (n=8, 2.4%). Late complications (after a month, 12 cases, 3.7%) were pericarditis and pericardial effusion (n=5, 1.5%), bar displacement (n=4, 1.2%), and hemothorax (n=3, 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease complication rate in later experience (Operation Date 1: 15/51 (29.4%) vs Operation Date 2: 34/284 (12.0%), p=0.004). Grand Canyon type (eccentric long canal type) showed higher complication rate than other types (GC type: 12/30(40%) vs Others: 37/305 (12.1%), p<0.001). Major risk factors are severity of pectus (OR=2.88, p=0.038), Grand Canyon type (OR=2.82, p=0.044), and Op. Date 1 (OR=4.05, p=0.001). Conclusion: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (Op. Date 1). Com-plication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with our current technique.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.523-526
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• 2008

Minimally Invasive repair of pectus excavatum using a metal bar, as advocated by Nuss, has been broadly accepted recently for its aesthetic aspect. There are and various treatment methods, as welt. Pectus excavatum may be accompaniedso many modified repair methods have been developed and performed. We report a case of a 33-year-old woman with pectus excavatum and breast hypoplasia, which were simultaneously corrected using a substernal steel bar and mammoplasty.