Single-centre Indian case series using X or cross bar for Nuss procedure in pectus excavatum
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CASE REPORT
Single-centre Indian case series using X or cross bar for Nuss procedure in pectus excavatum Laleng Mawia Darlong 1 Received: 18 May 2020 / Revised: 29 June 2020 / Accepted: 30 June 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract The modified Nuss procedure using two bars lying parallel or non-intersecting is use to correct pectus excavatum with varying degrees of patient satisfaction. This bar placement has its limitation for certain pectus excavatum morphology where the deformity is deep and focal or located below the subxiphoid. We have altered our bar placement so that bars intersects in an X or cross manner for such pectus morphology. We describe the X or cross bar placement and its specific indications based on morphology in a series of five patients from February 2019 until December 2019 with symmetrical focal deformity along the xiphisternum and asymmetric deformity below the xiphoid. The operating time varied from 90 to 120 min. There was no significant postoperative morbidity. They are on follow-up with period ranging from 4 to 15 months from the day of surgery. Early results show the X or cross bar Nuss procedure can be safely performed to achieve a desired long-term morphological correction of symmetric deep focal xiphisternal defects or asymmetric deformity below the xiphoid. Keywords X bar . Cross bar . Nuss procedure . Pectus excavatum
Introduction Pectus excavatum, also known as funnel chest, is one of the most common developmental disorders of the chest wall, comprising about 80% of the deformity. The deformity results in a symmetrical or asymmetrical depression of the sternum and adjacent rib cage, with the xiphisternum depression appearing most severe for lower sternal depression. The incidence and prevalence of pectus excavatum in India are not known; however, we are seeing cases across all groups in children, teenagers and adults coming to our clinic, seeking information and treatment after browsing the internet. Worldwide, the incidence reported is 1 in 400 to 1000 live births, with male predominance occurring 4 to 5 times, and tends to be sporadic or may be associated with connective tissue disorders, neuromuscular disease and a family history * Laleng Mawia Darlong [email protected] 1
Thoracic Oncosurgery and Chest Wall Deformity Clinic, Rajiv Gandhi Cancer Institute & Research Centre, Rohini, New Delhi 110085, India
[1]. Most of our patients in India seek consultation for cosmesis, psychological disturbances and nonspecific chest pain. They usually do not have symptomatic respiratory or cardiac dysfunction during normal sedentary activities. We have been performing a rather modified version of the Nuss procedure for pectus excavatum in India since 2012 using video-endoscope, pectus tunneloscopy along with various fixation devices and our described sutureless moon bridge system for a stable bar [2, 3]. A few reports on Nuss procedure for pectus excavatum from India can be traced back to Puri et al. who reported 2 cases in pediatric age group in
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