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Modified bilateral thoracoscopy-assisted Nuss procedure for repair of pectus excavatum after previous thoracic procedure

Background: Minimally invasive repair of pectus excavatum (PE) (Nuss procedure) was a transmediastinal procedure. Intrathoracic adhesion might increase the risks of this procedure. Patients after previous thoracic surgery might have the problem of intrathoracic adhesion increasing the surgical risks of Nuss procedure. PE after surgical repair was not a rare problem, especially in adults. In this study, we were to investigate the efficacy and safety of a modified Nuss procedure, using bilateral thoracoscopic approach, to repair recurrent or residual PE in adult patients. Materials and Methods: We retrospectively included all adults with PE corrected by modified bilateral thoracoscopy-assisted Nuss repair from January 2015 to December 2016. The clinical and surgical data of patients repaired with primary or secondary Nuss procedure were recorded and analyzed. Results: One hundred and fifty-one adult patients (136 men and 15 women) with a mean age of 26.3 years were included. Eleven patients (9 men and 2 women) were secondarily repaired due to prior failed Ravitch (three patients) or Nuss procedure (eight patients). The pectus repair was done using a single pectus bar (8.6%), 2 bars (81.5%), or 3 bars (9.9%). The rate of postoperative complications (6 months after operation) was significantly higher (P < 0.01) in the secondary repair group (two patients, 18.2%) compared to the primary repair group (seven patients, 9.3%), but it was still lower than most of the previous reports in the world (around 40%). Conclusion: All patients with PE had excellent postoperative outcomes in both the groups, even if with a slightly higher postoperative complication rate in the secondary repair group. The number of bar insertions was higher than previous data but with a lower complication rate. The modified bilateral thoracoscopy-assisted Nuss repair for adult patients after failed Ravitch or Nuss procedure was a safe and effective method and could have good early results.