MiniMinimallymally Invasive InvasivePectus Excavatum Repair:Pectus Excavatum Repair:

The Nuss ProcedureThe Nuss Procedure

Dr Osama BawazirFRCSI, FRCS(Ed), FRCS (glas), FRCSC.

Overview of Pectus ExcavatumOverview of Pectus Excavatum

• Incidence

• Associated Anomalies

• Investigation

• Methods of Repair

• Outcome

Chest Wall DeformitiesChest Wall Deformities

• Pectus Excavatum

• Pectus Carinatum

• Poland’s Syndrome• Sternal Defects

• Thoracic Dysplasia

Pectus ExcavatumPectus Excavatum

• Incidence: 1/1000 children (depending on criteria)

• Etiology: Typically idiopathic (80%)• Associated MSK defect (20%)• Scoliosis (most common)• Poland’s syndrome• Marfan’s, CP, CDH• Cardiac Defects (2%)

Pectus Excavatum: Clinical Pectus Excavatum: Clinical PresentationPresentation

• Evident at birth (80%)

• Deformity worsens with URTI

• Moderate and severe deformities associated with decreased exercise tolerance

Pectus Excavatum: EvaluationPectus Excavatum: Evaluation• History and Physical• CT Scan (Index: Transverse/AP)• Pulmonary Function Studies

• Echocardiogram

Treatment:• Mild: (CT index < 3) exercise and clavicle strap• Moderate/severe: (CT index > 3) operate IF:

• Patient Motivated • Functional Impairment

Pectus Excavatum: Surgical Pectus Excavatum: Surgical OptionsOptions

Open Repair (Ravitch)• Repair of cartilaginous

portion of ribs, preserving

perichondrium

Closed Repair (Nuss)• Insertion of corrective bar

(See Video)

Nuss procdureNuss procdure

• Intrathoracic bar implantation (controlled by thoracoscopy)

• Correction of sternum and funnel without resection of rips or cartilage

• Influence on the costo-sternal joints

From Nuss - original paper