Nuss Procedure for Pectus Excavatum

PA and lateral chest radiographs show a retrosternal Nuss bar in a patient following Nuss procedure. Note the retrosternal location (arrow) and the intercostal attachments (arrowheads) of the bar.

Facts: Nuss Procedure

• New approach to repair pectus excavatum
• Simple technique with better cosmetic results; aiming to elevate the deepest part of the depression
• Done by placing a retrosternal metallic bar through small incisions in the intercostal space. The bar penetrates the pleural cavity at the hinge point at either side.
• Several types of bars available to choose depending on the morphology of pectus excavatum
• It is important for surgeon to elevate the deepest part of the depression, which is not necessarily the center of the sternum!

Complications

• Most common = pneumothorax
• Followed by: bar displacement, seroma, pleural effusion, pericardial effusion
• Bar displacement can be: 1) flipping (most common), 2) lateral sliding, 3) backward shift

Reference:

Park et al. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg 2004;77:289-295.