New Berlin-Buch “Reversed Nuss,” Endoscopic Pectus Carinatum Repair Using Eight-Hole Stabilizers,Submuscular CO 2,and Presternal Nuss Bar Compression: First Results in 35 Patients

Abstract

Abstract

Introduction:

Since 2001 we minimized access (2.9–4.7 cm) for universally applicable endoscopic hybrid carinatum technique with two transsternal Willital bars in 173 endoscopic hybrid (EH) patients with very satisfactory results. In 2008–2009, endoscopic Nuss bar compression with endoscopic repair of costal flaring applied a new eight-hole stabilizer, which allows the use in pectus carinatum (PC) beyond adolescence including redos and combined deformities. This prospective study of 35 “endoscopic Berlin-Buch reversed Nuss” repairs intends to establish indications for this improved technique.

Materials and Methods:

In February 2008 to February 2010, we used endoscopic Nuss bar compression by applying a bilateral new eight-hole stabilizer fixed to the bar without screws or wires, which allows unprecedented versatility and the use in pectus carinatum beyond adolescence. Thirty-five patients aged 17.05 ± 10.2 years (range: 11.3–33.1 years) were recorded prospectively and followed at 3 monthly intervals. We implanted a standard Nuss bar (11–14′) into an endoscopically dissected submuscular presternal pocket correcting PC by sternal pressure. The bars were put under tension by traction via bilateral eight-hole stabilizers and three pericostal wire sutures on each side. Bars were removed after 2 years.

Results:

All 35 “reversed Nuss” pectus carinatum repairs, including 2 redos after Ravitch, were successful, with no conversion. So far there was no local or general complication and no seroma or bar dislocation. Thirty-one patients judged their result as excellent and 4 as good.

Conclusions:

Although this is a very early experience, “reversed Nuss” is safe and effective and new technical improvements have expanded the range of applicability to older patients and suitable redos.