Surgical Procedure Benefits

When comparing the Nuss Procedure to older “open” surgical options, there are several benefits of the procedure’s less invasive method.

The primary benefits include a shorter operating time, less blood loss, and smaller, less visible incisions.1 Some clinical data also suggests that because no cartilage or pieces of rib are being removed during the procedure, the patient’s chest and rib cage will be able to grow and repair itself in a natural manner.2

The combined effect of these benefits means that a patient’s body is subjected to less trauma compared to other open surgery options. The Nuss Procedure is a widely-accepted effective method for treating pectus excavatum.2


Research focusing on the Nuss Procedure indicates that post-operative patients, who have had the bar removed, show significant improvement in lung capacity as tested by “Forced Expiratory Volume in 1 Second” or FEV1. This data suggests that these patients have similar or equivalent lung function to healthy individuals with no history of Pectus Excavatum.3,4,5,6,7 This demonstrates that a patient’s lungs may be able to transfer more air and function more efficiently following treatment with the Nuss Procedure and removal of the Pectus Support Bar.8


Healthcare professionals use function tests to evaluate how well (or poorly) certain organs are working within the body. The results of function tests are always compared to a “reference range” which is a range of values that would be observed in healthy people of similar age, sex, race, etc. to the patient. Heart function is evaluated in this way.

Data shows that surgical correction of Pectus excavatum can improve specific heart function values. This means that:

  • The values may be within the reference range when they were not before surgery or
  • The values are closer to the reference range than before surgery.

The values are closer to the reference range than before surgery.

  • Improved “Maximum Cardiac Index” which is a measure of how well the heart performs compared to the size of the patient4,6
  • Improved “Stroke Index” which is a measure how efficiently a patient’s heart pumps blood4,6
  • Increased “Oxygen Pulse” which is a measure of the amount of oxygen delivered to the bloodstream during each heartbeat while the patient is resting4,6

All of the above measurements contribute to improved heart and lung function. Benefits of improved cardiopulmonary function might include more stamina during exercise, not tiring as quickly, and the ability to participate in sports for a longer period of time than was possible before the corrective procedure.9


When considering a corrective surgery, many patients are concerned that their deformity will reoccur. Published data evaluating the success rate of the Nuss procedure, indicates that recurrence is reported in less than 2% of cases.10,11,12,13,14,15,16 A high probability of successful deformity correction and a low chance of recurrence is a significant benefit of the Nuss Procedure.


Aside from the potential physical benefits of the Nuss Procedure, surgeons may assert that humanistic or quality-of-life measures such as “satisfaction with appearance” and “increased confidence after surgery” should also be considered when evaluating the success of the surgery.17,18 Some of the more common aspects of humanistic outcomes include:

  • Confidence towards change of appearance after surgery
  • Better body feeling after surgery
  • Better self-acceptance after surgery
  • General satisfaction
  • General interest in sports
  • Higher self-confidence after surgery
  • Being more sociable after surgery

The response data in clinical research shows that patient satisfaction after surgery is high and approximately 82% of parents believe their child to be “satisfied” or “very satisfied” with the results. These results indicate that the likelihood of a patient being satisfied with the results of the Nuss Procedure, barring complications, is high.18,19

  1. Nuss, Donald, et al. “A 10-year review of a minimally invasive technique for the correction of pectus excavatum.” Journal of pediatric surgery 33.4 (1998): 545-552
  2. Protopapas, Aristotle D., and Thanos Athanasiou. “Peri-operative data on the Nuss procedure in children with pectus excavatum: independent survey of the first 20 years’ data.” Journal of Cardiothoracic Surgery 3.1 (2008): 40.
  3. Kubiak R, Habelt S, Hammer J, Hacker FM, Mayr J and Bielek J. Pulmonary function following completion of Minimally Invasive Repair for Pectus Excavatum (MIRPE). Eur J Pediatr Surg. 2007 Aug;17(4):255-60.
  4. Maagaard M, Tang M, Ringgaard S, Nielsen HH, Frokiaer J, Haubuf M, Pilegaard HK and Hjortdal VE. Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation. Ann Thorac Surg. 2013 Jul;96(1):272-8.
  5. O’Keefe J, Byrne R, Montgomery M, Harder J, Roberts D and Sigalet DL. Longer term effects of closed repair of pectus excavatum on cardiopulmonary status. J Pediatr Surg. 2013 May;48(5):1049-54.
  6. Sigalet DL, Montgomery M, Harder J, Wong V, Kravarusic D and Alassiri A. Long term cardiopulmonary effects of closed repair of pectus excavatum. Pediatr Surg Int. 2007 May;23(5):493-7.
  7. Tang M, Nielsen HH, Lesbo M, Frokiaer J, Maagaard M, Pilegaard HK and Hjortdal VE. Improved cardiopulmonary exercise function after Nuss operation for pectus excavatum. Eur J
  10. Aronson DC, Bosgraaf RP, van der Horst C and Ekkelkamp S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World J Surg. 2007 Jan;31(1):26-9; discussion 30.
  11. Densmore JC, Peterson DB, Stahovic LL, Czarnecki ML, Hainsworth KR, Davies HW, Cassidy LD, Weisman SJ and Oldham KT. Initial surgical and pain management outcomes after Nuss procedure. J Pediatr Surg. 2010 Sep;45(9):1767-71
  12. Fallon SC, Slater BJ, Nuchtern JG, Cass DL, Kim ES, Lopez ME and Mazziotti MV. Complications related to the Nuss procedure: minimizing risk with operative technique. J Pediatr Surg. 2013 May;48(5):1044-8.
  13. Gould JL, Sharp RJ, Peter SD, Snyder CL, Juang D, Aguayo P, Fraser JD and Holcomb GW, 3rd. The Minimally Invasive Repair of Pectus Excavatum Using a Subxiphoid Incision. Eur J Pediatr Surg. 2016 Aug 14.
  14. Han Y, Wang J, Li W, Gu Z, Zhang T, Lu Q and Li X. Non-thoracoscopic extrapleural Nuss procedure for the correction of pectus excavatum in children. Eur J Cardiothorac Surg. 2010 Feb;37(2):312-5.
  15. Mao YZ, Tang ST, Wang Y, Tong QS and Ruan QL. Nuss operation for pectus excavatum: a single-institution experience. World J Pediatr. 2009 Nov;5(4):292-5.
  16. Park HJ, Kim JJ, Park JK and Moon SW. A cross-sectional study for the development of growth of patients with pectus excavatum. Eur J Cardiothorac Surg. 2016 Dec;50(6):1102-1109.
  17. Hadolt B, Wallisch A, Egger JW and Hollwarth ME. Body-image, self-concept and mental exposure in patients with pectus excavatum. Pediatr Surg Int. 2011 Jun;27(6):665-70.
  18. Lam MW, Klassen AF, Montgomery CJ, LeBlanc JG and Skarsgard ED. Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures. J Pediatr Surg. 2008 May;43(5):819-25.
  19. Lomholt JJ, Jacobsen EB, Thastum M and Pilegaard H. A prospective study on quality of life in youths after pectus excavatum correction. Ann Cardiothorac Surg. 2016 Sep;5(5):456-465.

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Talk to your surgeon about whether the MIRPE/Nuss procedure is right for you and the risks of the procedure, including the risk of implant wear, loosening or failure, and pain, swelling and infection. Zimmer Biomet does not practice medicine; only a surgeon can answer your questions regarding your individual symptoms, diagnosis and treatment.