Comparison of the Nuss procedure for pectus excavatum by age and uncommon complications

BACKGROUND: We summarized our experience of the Nuss procedure for pectus excavatum with comparison by age and uncommon complications. METHODS: Twenty-three patients underwent the Nuss procedure. Their age ranged from 3 to 19 years old. The outcome was compared between two groups divided by age: teenagers (> or = 13 yrs old, n = 5, Group 1) and younger patients (n = 18, Group 2). RESULTS: Cosmetic results were significantly better, and the operating time and postoperative hospital stay in Group 2 were significantly shorter than in Group 1. Complications were more frequently seen in Group 1 than in Group 2. In all three younger patients whose bars were removed after 2 years, the ribs holding the bar were deformed. Uncommon complications occurred in two cases. In one case, pneumothorax occurred due to laceration by a fragment of wire after 12 months, and the fragment fell into the thoracic cavity. In another case, pneumothorax occurred due to injury by the port of a thin thoracoscope. CONCLUSION: The teenaged patients had more complications and poorer cosmetic results. Therefore, this operation should be performed before the teenage years. In younger patients with rapid growth, the bar should be removed less than 2 years to prevent restriction of costal growth.