Thoracoscopy-assisted modified Nuss procedure for the treatment of pectus excavatum in children: a retrospective single-center experience.

OBJECTIVES

This research aimed to evaluate the safety and efficacy of the thoracoscopy-assisted modified Nuss procedure for the treatment of pectus excavatum in children at our hospital.

METHODS

A retrospective analysis was conducted on patients with pectus excavatum who underwent surgery between January 2023 and June 2025 at our hospital. In all, 199 patients underwent the thoracoscopy-assisted modified Nuss procedure (MP group), whereas 32 underwent the thoracoscopy-assisted traditional Nuss procedure (TP group). Additionally, the patients were divided into two groups based on the number of bars implanted: the single-bar group (SB group) and the double-bar group (DB group).

RESULTS

A total of 231 patients were included, comprising 176 males and 55 females. The age range was 3.00-18.00 years, with a median of 12.00 years (interquartile range [IQR]: 10.00-14.00 years). The postoperative hospital stay ranged from 3.00 to 18.00 days, with a median of 6.00 days (IQR: 5.00-8.00 days). The incidence of surgical complications was low (8.65%). Each case showed an improvement in Haller index (HI), and both the children and their parents were satisfied with the postoperative chest appearance. Statistical analysis showed that significant differences were found between the MP and TP groups in operation time [median 65.00 min (IQR 55.00-65.00 min) vs. 87.50 min (80.00-93.75 min), P < 0.001], postoperative pain score [6.00 (5.00-6.00) vs. 6.00 (5.00-7.00), P < 0.05], and postoperative hospital stay [6.00 days (5.00-7.00 days) vs. 9.00 days (7.25-11.00 days), P < 0.001]. In addition, significant differences were observed between the SB and DB groups in age [12.00 years (10.00-13.00 years) vs. 4.10 years (3.56-4.90 years), P < 0.001], operation time [65.00 min (55.00-65.00 min) vs. 95.00 min (90.00-101.25 min), P < 0.001] and postoperative hospitalization time [6.00 days (5.00-7.00 days) vs. 7.50 days (6.00-11.00 days), P < 0.05].

CONCLUSIONS

Our results showed that compared to the traditional Nuss procedure, the thoracoscopy-assisted modified Nuss procedure achieved a comparable correction of the HI while offering shorter operation time, lower postoperative pain score, and shorter postoperative hospital stay, which may be suitable for pediatric patients with pectus excavatum.