An Initial 5-Year Single-Center Experience of 365 Patients Undergoing the Video-Assisted Thoracoscopic Surgery for Nuss Procedure for Pectus Excavatum in Resource-Scare Setting

The-May Nguyen; Van-Thieu Le; Huu-Uoc Nguyen; Huu-Lu Pham; Hong-Son Duy Phung; Ngoc-Tu Vu; Viet-Anh Nguyen; Nam-Khanh Do; Kim-Duy Vu; Hoang-Long Vo; Quoc-Hung Doan

doi:10.3389/fsurg.2021.693562

An Initial 5-Year Single-Center Experience of 365 Patients Undergoing the Video-Assisted Thoracoscopic Surgery for Nuss Procedure for Pectus Excavatum in Resource-Scare Setting

Front Surg. 2021 Jun 14:8:693562. doi: 10.3389/fsurg.2021.693562. eCollection 2021.

Authors

The-May Nguyen¹, Van-Thieu Le¹, Huu-Uoc Nguyen^{2

3}, Huu-Lu Pham², Hong-Son Duy Phung², Ngoc-Tu Vu^{2

4}, Viet-Anh Nguyen², Nam-Khanh Do⁵, Kim-Duy Vu⁵, Hoang-Long Vo⁵, Quoc-Hung Doan^{2

3}

Affiliations

¹ Department of Cardiovascular and Thoracic Surgery, Viet-Tiep Friendship Hospital, Hai Phong, Vietnam.
² Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam.
³ Department of Surgery, Hanoi Medical University, Hanoi, Vietnam.
⁴ Department of Cardiovascular and Thoracic Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam.
⁵ Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Abstract

Background: Little is known about video-assisted thoracoscopic surgery in the Nuss procedure (VATS-NUSS) and its postoperative outcomes in the resource-scarce conditions in clinical practice such as Vietnam. Available evidence in the literature was mostly reported from large institutions in developed countries. Hence, this study was conducted to review our initial large single-center experience in the use of the VATS-NUSS for patients with pectus excavatum (PE) within 5 years. Methods: Data from 365 consecutive PE patients between January 2015 and December 2019 who were surgically treated with VATS-NUSS were retrospectively analyzed. Results: Of 365 patients, median age at operation was 15.61 ± 3.73 years (range = 5-27 years), most being child and adolescent. Three hundred nine patients (84.65%) were male. PE was commonly detected at puberty (n = 328, 89.9%). Postoperatively, early complications consisted 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%). Late complications included 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%). No deaths occurred. In 175 patients (47.95%) experiencing bar removal, mean operative time for bar removal was 34.09 ± 10.61 min, and the length of hospitalization following bar removal was 2.4 ± 1.34 days; the most frequent complication was pneumothorax (n = 19, 10.85%). One wound infection and one incision fluid accumulation happened following bar removal. Favorable midterm to long-term postoperative outcomes were achieved. Conclusions: From the beginning of the Vietnamese surgeons' experience, VATS-NUSS application obtained favorable outcomes with minimizing the occurrence of serious intraoperative and postoperative complications. Current rare evidence enables to give a real picture in the application, modification, and development of VATS-NUSS in the countries having similar resource-scarce conditions.

Keywords: Nuss; VATS; complications; congenital pectus excavatum; thoracoscopic surgery.