OBJECTIVETo investigate the improvement of the Nuss procedure with the classification of the pectus excavatum by symmetry and extend the indication of the operation for a better outcome.

METHODSThe clinic data of 403 patients who underwent repair of pectus excavatum by Nuss technique and its modifications from July 2002 to September 2007 were reviewed retrospectively. There were 299 male patients and 104 female patients. The age ranged from 2 years and seven months old to 32 years old, with a mean of (8.0 +/- 5.1) years old. The entire group of the CT index ranged from 3.25 to 51.20, with a mean of (5.0 +/- 3.0). According to the morphology of the pectus and practically the bar shaping, Park's classification was simplified to symmetric type, eccentric type, and unbalanced type. The patients of symmetric type were all received original Nuss procedure, and the other two types underwent the procedure using characteristic bar shaping and technical modification.

RESULTSAmong the 403 patients, 257 patients (63.8%) were symmetric pectus excavatum, and 48 patients (11.9%) were eccentric, other 98 patients (24.3%) were unbalanced type. All the patients underwent the procedure successfully. The total time of the procedure ranged from 30 to 165 min, with a mean of (45.7 +/- 12.6) min. Volume of blood loss during the operation ranged from 1 to 80 ml, with a mean of (4.8 +/- 6.2) ml. The days of hospitalization ranged from 4 to 12 d, with a mean of (7.1 +/- 1.0) d. The duration of following up ranged from 1 month to 5 years, and the results of the repair were excellent in 391 patients (97.0%). Five patients received a further operation, including 1 patient of recurrent pectus excavatum caused by bar displacement, 4 patients of protruding side way. There were 23 patients of complications for an overall complication rate of 5.7%. And the other 18 patients of complications included 2 patients of pericardium perforation, 2 patients of bar displacements caused intercostal dilaceration, 2 patients of diaphragmatic muscle injuries, 1 patient of hemothorax, 8 patients of pneumothorax, 2 patients of intermittent pains for 2 months, 1 patient of scoliosis caused by persistent pain.

CONCLUSIONTo classify the pectus excavatum with symmetry and to choose different ways of procedure can extend the indication of Nuss procedure and receive a better outcome.