WOFAPS 2025 8th World Congress of Pediatric Surgery

Zafer Alparslan ¹, Mustafa Yüksel ²

¹ Marmara University School of Medicine
² Demiroglu Bilim University School of Medicine, Thoracic Surgery Department

Introduction
Nuss procedure remains being mainstay surgical procedure to treat pectus excavatum (PE) with its minimal invasive nature and mild complications profile. Procedure is modified throughout the years as studies published. Due to the low number of performing centers, clinical findings are important to excel management of PE. In that context, we present our clinical experiences.

Methods
This study includes all patients (n=1087) that underwent Nuss procedure by single surgeon at two centers (2005-2019 and 2019-2025). Patients’ data including age, gender, family history, operation duration, bar counts and complications were investigated retrospectively.

Results
Patients (n=1087) presented with mean age of 18,74 +-6,64 ranging through 4-58 with male dominance (84,7%). Family history regarding any pectus type was notable (%13,0). Most of the deformities were symmetrical (%73,9). The mean bar count was 1,55 +- 0,63 correlating with operation duration and age of patients. (r=0.35, r=0.22). Cross-bar technique was introduced in 2016 and performed on selected patients (n=151, %13,9) with significantly higher age (21,05 +- 8,26) without increased complications rates. The mean duration of bars in-situ was 34,98 +- 14,97 months for the patients that underwent bar removal surgery. Most extreme per-op complication was atrial perforation seen in only two patients (0,2%) whereas most common early post-op complication was pneumothorax (%1,7) No fatal complication and death was reported.

Conclusion
Nuss procedure is a safe and minimal invasive technique for the treatment of pectus excavatum, having developed throughout years from one bar to multiple cross bars options, with experienced centers and surgeons. Patients’ age may indicate the need for more bars and longer operation duration. Cross-bar technique, reserved for more complex cases, seems safe and effective. Most of the patients comply with recommended in-situ duration of bars.