Non-thoracoscopic extrapleural Nuss procedure for the correction of pectus excavatum in children

The aim of this study was to evaluate the efficacy and safety of non-thoracoscopic extrapleural approach of the Nuss procedure for the correction of pectus excavatum in children.From October 2007 and January 2009, 42 patients with pectus excavatum were treated in the Tangdu Hospital, Xi'an, China, with surgical correction through the Nuss procedure. Among them, 20 underwent a Nuss procedure with thoracoscopic guidance, and the other 22 patients were treated with non-thoracoscopic extrapleural approach, in which a bilateral extrapleural tunnel to the edge of sternum was created using a blunt dissection through bilateral thoracic skin incisions. Without introducing the thoracoscopy into the thoracic cavity, a steel bar was inserted in the entirely extrapleural tunnel and turned as in the standard Nuss procedure.The operations were completed successfully in all patients treated. The operation time and postoperative hospitalisation time of the non-thoracoscopic extrapleural Nuss group were significantly less than those of the thoracoscopic group (P<0.05). There was no pneumothorax or hydrothorax in our series and no tube thoracostomy was further needed. All patients were followed up for more than 2 months, and the surgical outcomes were excellent.The non-thoracoscopic extrapleural approach of the Nuss procedure is a safe and less traumatic procedure for the correction of pectus excavatum.