Nuss Procedure: Decrease in Bar Movement Requiring Reoperation with Primary Placement of Two Bars

Background: The Nuss procedure, first reported in 1998, is currently the treatment of choice for pectus excavatum. The most significant bar-related complication documented is bar movement, requiring reoperation in 3.4%–27% of reports. Our report compares the initial placement of one Nuss bar versus two to prevent bar displacement. Subjects and Methods: An Institutional Review Board–approved, retrospective chart review was performed of all Nuss procedures performed from November 2000 through February 2010. Since November 2006, all initial Nuss procedures were started with the intent of placing two bars. Haller index, patient demographics, duration of surgery, length of stay, postoperative wound infections, and bar movement requiring reoperation were collected and compared for the one-bar versus two-bar patient populations. Results: In total, 85 Nuss procedures (58 with one-bar and 27 with two-bar primary Nuss procedures) were analyzed. Two attending pediatric surgeons performed all the procedures. Reoperation for bar movement when one bar was initially placed occurred in 9 patients (15.5%). No patients with initial placement of two bars required operative revision for a displaced Nuss bar (15.5% versus 0%, P = .05). Patient age and Haller index were not statistically different between groups. Conclusions: Our data demonstrate improved bar stability with no reoperative intervention when pectus excavatum is initially repaired with two Nuss bars. Primary placement of two bars has now become standard practice in our institution for correction of pectus excavatum by the Nuss procedure and would be our recommendation for consideration by other centers.