Abstract:

Objective To investigate the outcomes of modified Nuss procedure with a subxiphoid incision in treatment of recurrent pectus excavatum. Methods From July 2007 to August 2010, 22 patients with recurrent pectus excavatum underwent a secondary repair using the modified Nuss procedure with a subxiphoid incision. Conditions of first repair, symptom, Haller index, operation course and complications before second repair, and follow up after second repair were retrospectively analysed. Besides, another 51 patients with pectus excavatum undergoing first Nuss procedure in the same period were served as control group. Results Among the 22 patients with recurrent pectus excavatum, there were 12 cases of Ravitch procedure, 7 cases of modified Ravitch procedure and 3 cases of sterno-turnover procedure in the first repair. The symptoms before the second repair included decreased endurance, dyspnea on exertion, chest pain, frequent respiratory infection and palpitation. The average Haller index was 4.81±0.8. The average duration of reoperation was significantly longer than that of control group (P<0.05). There was no significant difference in volume of blood loss, duration of postoperative hospitalization and prevalence of postoperative complications (pneumothorax, pleural effusion, persistent pain and wound infection in lateral incision) between two groups (P>0.05). There was no case of perioperative death or cardiac perforation in two groups. The patients were followed up for 1 to 4 years, the preoperative symptoms significantly alleviated or disappeared. The steel bars were demolished in 9 patients, and no steel bar malposition and stabilizer displacement was found. Conclusion Although recurrent pectus excavatum repair is technically challenging, the modified Nuss procedure with a subxiphoid incision can be performed safely, and may be an alternative approach in treatment of patients with recurrent pectus excavatum.

Key words: pectus excavatum, recurrence, reoperation, minimally invasive, Nuss procedure