People with pectus excavatum have an indented chest and in some cases this can lead to physical or psychosocial symptoms. In moderate to severe cases, surgery to correct the deformity may be warranted. The most common procedure is called the Nuss Procedure, in which metal bars are placed under the chest to lift the sternum. The bars are removed several years later.
Many important questions about this surgery remain to be answered: When is the ideal age to have the procedure? How long should the bars remain in the chest? What is the risk of recurrence?
In a new research study published in the Journal of Pediatric Surgery, physician researchers from Japan examined data from 42 patients who underwent the Nuss Procedure. They only included patients that had at least 5 years of follow-up data. The study included 35 boys and 7 girls. The average age of the patients was 6 years old.
The researchers measured the Haller index -- a ratio of the transverse diameter of the chest to the depth of the deformity -- at different time points. The average Haller index before the operation was 5.07. The average Haller index immediately after bar implantation was 2.46 and five years after surgery the average Haller index was 3.18.
At the group level, the results suggested that at 5 years after surgery there was at least some worsening compared to the initial improvement immediately after surgery. Specifically, out of the 42 patients, 5 patients had clinically significant worsening of their pectus at five years after surgery compared to immediately after surgery. Of these, 3 patients underwent a repeat procedure.
In 12 out of the 42 patients, there was mild depression seen at five years after surgery compared to immediately after surgery, but no clinical intervention was warranted. In 25 out of 42 patients, there was no difference in the pectus severity at five years after surgery compared to immediately after surgery.
Overall the researchers found that in patients under 10 years old there is a recurrence risk five years after surgery of about 10%, and a repeat-operation risk of about 7%.
During the Nuss Procedure surgeons typically attempt to correct the chest slightly more than what is necessary with the expectation that there may be slight recurrence of the pectus deformity years after the surgery. It is important to ask your surgeon about this.
Much more research is needed. Data beyond five years after surgery are lacking. In this study all patients were younger than 10 years old, so it is still unknown how these recurrence rates would change based on age at surgery.