A different application of nuss procedure in a difficult case of pectus excavatum

Author(s): Halil Tözüm, Murat DemiroÄŸlu and Kamil Kaynak

Abstract: A 17 year-old male patient who had a history of Nuss procedure 8 months ago with a diagnosis of pectus excavatum, the bar had been removed with left anterior thoracotomy due to complications such as bar dislocation, hemothorax and infection. Minimally invasive reoperation was performed on the patient who had an asymmetrical collapse distinctive on the right side. Classical Nuss operation was not possible due to strong adhesions that developed after past procedures. At this point, instead of open surgery, we entered the thoracic cavity with two new incisions performed on the two peak points of the collapse. A tunnel was formed beneath the sternum with obtuse and sharp opposing dissections through the newly formed holes. Subsequently, subcutaneous tunnels were opened up to the new entry holes through the initial incisions that were formed left and right previously. The bar was swiped under the sternum and rotated by using the subsequent holes as entry and exit holes for the bar. It was immobilized with a stabilizer. No complications occurred in the postoperative period. Pleural adhesions are accepted as one of the most important contraindications of thoracoscopic surgery. Nevertheless, with the help of two incisions in addition to the main procedure we present our case of re-operated pectus excavatum with a minimally invasive procedure and a successful outcome.

DOI: https://doi.org/10.22271/ortho.2017.v3.i2g.65