Complications associated with the Nuss procedure: continued evolution of the learning curve

Vegunta, Ravindra K.; Pacheco, Paul E.; Wallace, Lizabeth J.; Pearl, Richard H.

doi:10.1016/j.amjsurg.2007.12.015

« Previous Next »The American Journal of Surgery
Volume 195, Issue 3 , Pages 313-317, March 2008

Complications associated with the Nuss procedure: continued evolution of the learning curve

Ravindra K. Vegunta, M.D., F.A.C.S.
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
- Children’s Hospital of Illinois, 420 NE Glen Oak Dr., Suite 201, Peoria, IL 61603, USA
Paul E. Pacheco, M.D.
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
- Children’s Hospital of Illinois, 420 NE Glen Oak Dr., Suite 201, Peoria, IL 61603, USA
Lizabeth J. Wallace, R.N., M.S., C.P.N.P.
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
- Children’s Hospital of Illinois, 420 NE Glen Oak Dr., Suite 201, Peoria, IL 61603, USA
Richard H. Pearl, M.D., F.A.C.S.
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
- Children’s Hospital of Illinois, 420 NE Glen Oak Dr., Suite 201, Peoria, IL 61603, USA
- Corresponding author. Tel.: +1-309-624-8951; fax: +1-309-655-3948.

Received 16 November 2007; received in revised form 11 December 2007 published online 21 January 2008.

Abstract

Background

We report unusual and/or significant complications encountered during and after the Nuss Procedure for pectus excavatum.

Methods

This was a retrospective review that was approved by the institutional review board, with parental consent.

Results

Seven patients had unique and/or significant complications as follows: (1) laceration of an internal mammary artery during bar placement requiring emergent minithoracotomy; (2) hemopericardium 10 weeks postoperatively after blunt chest trauma requiring exploration of the pericardium and clot evacuation; (3) almost complete recurrence of the pectus excavatum deformity immediately after bar removal; (4 and 5) immediate/early postoperative bar displacement requiring re-operation and placement of 2 bars each; and (6 and 7) almost complete neo-ossification of the Nuss bar, making removal challenging.

Conclusions

The Nuss procedure has met with near-universal acceptance. Complications are just being reported. We describe 7 events to add to the evolving literature as the entire pediatric surgery community participates in the initial learning curve.

Keywords: Pectus excavatum, Nuss procedure, Complications