365 Patients with Pectus Excavatum Undergoing Video-Assisted Thoracoscopic Surgery for the Nuss Procedure: A 5-Year Single-Institution Experience
Authors: May Nguyen The , Uoc  , Lu  , Son  , Tu  , Anh Nguyen Viet , Do M.Sc. Khanh Nam , Vu Kim-Duy , Vo Hoang-Long , Hung  
Published: September 2020

Abstract
Objective: We conducted this study to review our large single-center experience in Vietnam in the use of the VATS-NUSS for 365 consecutive patients with PE within the five years and to evaluate mid-term to long-term outcome in these patients. Methods: In this retrospective study, we consecutively selected the patients with the diagnosis of PE who underwent VATS-NUSS from January 2015 to September 2019. A total of 365 patients who were surgically treated for PE at the Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital (Hanoi, Vietnam) was included in final analysis. Results: The length of postoperative hospitalization ranged from 1 to 13 days (Mean: 5.1). Early postoperative complications were recorded up to 30 days during hospital stay, consisting of pneumothorax (n = 5, 1.37%), pleural bleeding / pleural fluid (n = 2, 0.55%), pleural hematoma (n = 1, 0.27%), pneumonia (n = 1, 0.27%), surgical wound infection (n = 1, 0.27%), incision fluid accumulation (n = 3, 0.82%), metal bar infection (n = 1, 0.27%), atelectasis (n = 3, 0.82%), and fever (n = 8, 2.19%). In the late postoperative complications, surgical wound infection (n = 2, 0.55%), metal bar deviation (n = 5, 1.37%), metal bar allergy (n = 10, 2.74%), recurrent PE (n = 2, 0.55%), and persistent PE (n = 5, 1.37%) were observed. No deaths occurred. The outcomes related to the bar removal that was carried out in 175 patients (47.95%). The time the bar was in situ ranged from 2 to 49 months (mean: 28.89±7.48 years). The mean operative time at bar removal was 34.09 ± 10.61 minutes, and the length of hospitalization following bar removal was 2.4 ± 1.34 days. Of 175 patients performed bar removal, the most frequent complication was pneumothorax, which was diagnosed in 19 (10.85%) patients; surgical wound infection in 1 patient and incision fluid accumulation in 1 patient were observed following bar removal. Towards mid-term results at 6 – 30 months postoperatively, there were 124 out of 365 patients (33.97%). Of 124 patients, most patients were unremoved the bar (n = 121, 97.58%), and only 3 patients were removed the bar (2.42%). Most patients had body weight gain (n = 97, 78.23%), and increased physical activity and improved health (n = 115, 92.74%). The Haller index on chest X-ray was 2.44 ± 0.15. 220 out of 365 patients (60.27%) were postoperatively evaluated long-term results at over 30 months. Of those, 172 received bar removal (78.18%) and 48 have not yet received bar removal (21.82%). 217 patients (98.64%) had both body weight gain, and increased physical activity and improved health. The Haller index on chest X-ray was 2.45±0.21. Conclusions: The VATS-NUSS for PE was safe and effective approach with minimizing the occurrence of serious intra- and postoperative complications. From our initial one-institution experience in a resource-scare country, good mid-term to long-term postoperative outcomes in PE patients were obtained with VATS-NUSS. Current rare evidence drawn from this cohort enables to give a real picture in the application, modification and development of VATS-NUSS not only for Vietnam but also the countries having similar resource-scare conditions.