The effect of thoracoscopy upon the repair of pectus excavatum

Background/aims

The Nuss procedure is the most commonly performed operation to correct pectus excavatum (PE). Thoracoscopic assistance has been anecdotally noted to improve the safety of this operative approach. This study aimed to compare complications and clinical outcomes before and after the introduction of thoracoscopy in a single-center.

Methods

A retrospective review was performed of all patients who underwent the Nuss procedure at The Royal Children's Hospital over an 11-year period (2005–2015), collecting data on all intra-operative and post-operative outcomes.

Results

A total of 217 Nuss procedures were performed (122 non-thoracoscopic pectus repairs, 95 thoracoscopic pectus repairs). Median patient age was 14.9 years, with the majority male (185/217, 84.3%). Patient demographics (age, gender, defect severity) and postoperative recovery were comparable between the two groups. Major complications included cardiac arrest requiring internal cardiac massage, hemothorax, pneumothorax, empyema, bar displacement and infection. The overall major complication rate was low (19/217, 8.8%); however, there was a significant reduction in major complications in the thoracoscopic pectus repair group (13.1% versus 3.2%, p = 0.02).

Conclusions

Thoracoscopic vision during the Nuss procedure reduces the risk of major complications.

Level of evidence

Treatment study – Level III (Retrospective comparative study).