Comparison of Single-Incision vs Non-Flipping Bar Nuss Procedures in Pediatric PE

Overview

This retrospective study compared two modified Nuss procedures for pectus excavatum correction in 171 pediatric patients. Both single-incision and non-flipping bar techniques demonstrated comparable safety, efficacy, and postoperative recovery, with differences in operative time and incision number reflecting patient selection.

Background

Pectus excavatum (PE) is the most common congenital chest wall deformity, often requiring surgical correction when moderate to severe. The minimally invasive Nuss procedure is standard in children and adolescents, with modifications developed to improve safety and outcomes. Two such variants include the single-incision modified Nuss and the modified Nuss with a non-flipping bar, each tailored to patient age and deformity characteristics. Comparative data between these techniques in pediatric populations remain limited.

Data Highlights

Key Findings

• The non-flipping bar group had longer operative times and more incisions compared to the single-incision group.
• Screw fixation was less frequently used in the non-flipping bar approach.
• Postoperative Haller index was slightly higher in the non-flipping bar group, but without significant clinical impact.
• No significant differences were observed in complication rates or postoperative recovery between groups.
• Therapeutic efficacy was comparable between the two surgical techniques after propensity score matching.
• Surgical technique selection was influenced by patient age, chest wall compliance, and deformity complexity.

Clinical Implications

Both modified Nuss procedures are effective and safe for pediatric PE correction, allowing surgeons to tailor technique choice based on individual patient factors such as age and chest wall rigidity. The single-incision approach may offer advantages in operative time and fewer incisions, while the non-flipping bar technique may be preferable in older patients or complex deformities. Awareness of these differences can guide preoperative planning and shared decision-making.

Conclusion

The single-incision modified Nuss and the modified Nuss with non-flipping bar procedures provide comparable outcomes in pediatric pectus excavatum correction. Individualized surgical selection based on patient and deformity characteristics optimizes safety and efficacy.

Related Resources & Content

1. Evaluation of Surgical Techniques for Pectus Excavatum in Pediatric Patients: A Retrospective Analysis from a Single Institution, 2023