Minimally Invasive Pectus Excavatum Repair: The Nuss Procedure

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Presentation transcript:

Minimally Invasive Pectus Excavatum Repair: The Nuss Procedure Dr Osama Bawazir FRCSI, FRCS(Ed), FRCS (glas), FRCSC.

Overview of Pectus Excavatum Incidence Associated Anomalies Investigation Methods of Repair Outcome

Chest Wall Deformities Pectus Excavatum Pectus Carinatum Poland’s Syndrome Sternal Defects Thoracic Dysplasia

Pectus 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 Presentation Evident at birth (80%) Deformity worsens with URTI Moderate and severe deformities associated with decreased exercise tolerance

Pectus 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 Options Open Repair (Ravitch) Repair of cartilaginous portion of ribs, preserving perichondrium Closed Repair (Nuss) Insertion of corrective bar (See Video)

Nuss 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