Introduction: Pectus excavatum is the most common congenital chest wall deformity, characterized by posterior displacement of the sternum and adjacent costal cartilages. In severe cases, it can impair cardiopulmonary function and negatively affect the quality of life due to physical limitations and psychosocial distress.Aim: To present current modifications of the Nuss procedure and assess their impact on the safety, postoperative outcomes, and patient comfort of surgical treatment for pectus excavatum.Methods: A narrative review based on a comprehensive analysis of relevant literature was conducted, focusing on advancements and technical modifications of the original Nuss technique.Results: Since its introduction in 1998, the Nuss procedure has become the standard minimally invasive approach for correcting pectus excavatum. Various modifications – such as changes in bar design, stabilization methods, use of thoracoscopy, and postoperative pain management protocols – have improved surgical outcomes and reduced complication rates. These advancements have increased the procedure’s safety and patient comfort, while maintaining high correction efficacy.Conclusions: The evolution of the Nuss procedure has significantly enhanced the surgical management of pectus excavatum. Ongoing refinements continue to optimize patient outcomes, making the technique safer, more comfortable, and more widely applicable across age groups.

Introduction: The Nuss procedure is the gold standard for correcting pectus excavatum. Despite its effectiveness, the postoperative period is often associated with significant pain, which may persist for weeks and typically requires intravenous analgesia, often opioid-based. Cryoanalgesia, a reversible method that induces temporary intercostal nerve block, offers a safe alternative providing both early and long-lasting pain relief. Aim: This study evaluates the impact of intraoperative intercostal nerve cryoanalgesia on postoperative pain intensity and hospitalisation duration in patients undergoing the Nuss procedure for pectus excavatum. Material and methods: A retrospective analysis was performed on 57 patients treated over a 7-year period at a single centre. Patients were divided into two groups: those who received intraoperative cryoanalgesia (n = 41) and those without additional intraoperative analgesia (n = 16). Statistical analysis was performed using the Mann–Whitney test and Spearman rank correlation, with significance set at p < 0.05. Results and discussion: Among the 57 patients, 53 (93%) were male, with a mean Haller Index of 3.98 and Correction Index of 33.78. Cryoanalgesia was applied in 71.9% of cases. Patients treated with cryoanalgesia demonstrated shorter hospital stays compared with the control group (3 ± 2 days vs. 5.5 ± 2 days; p < 0.001). Postoperative pain intensity measured by NRS was comparable between groups; however, opioid requirements were significantly lower in the cryogroup on day 3 (34% vs. 69%; p = 0.02) and day 4 (7% vs. 62.5%; p < 0.001). Conclusions: Intraoperative cryoanalgesia reduces hospitalisation time and postoperative opioid use, offering an effective adjunct for pain management after the Nuss procedure.

Background: Congenital bronchopleural fistula is an exceptionally rare cause of persistent neonatal air leakage. Most bronchopleural fistulas in newborns are related to mechanical ventilation, infection, or iatrogenic injury. The clinical presentation can suggest pneumothorax commonly seen in premature infants, diagnosis is often delayed, and an ongoing uncontrolled air leak may significantly compromise effective ventilation. Case presentation: A female neonate was delivered at 29 weeks of gestation with a birth weight of 1,360 g and Apgar scores of 6, 7, and 9. Immediately after birth, she developed progressive respiratory failure. Bilateral pneumothoraces were diagnosed, including a left tension pneumothorax. Despite two pleural drains and active suction, a continuous air leak persisted at approximately 800 mL/min, corresponding to the infant’s entire minute ventilation. Chest computed tomography demonstrated a communication between the left bronchial tree and the pleural cavity, consistent with a bronchopleural fistula. Dedicated CT angiography was not performed because of deterioration and the need to avoid delaying definitive treatment. Selective bronchial intubation, temporary bronchial occlusion with a Fogarty catheter, and minimally invasive options were considered. Owing to respiratory instability despite drainage, surgical treatment was selected. Thoracoscopy identified the lesion, but secure closure could not be achieved thoracoscopically; the procedure was converted to thoracotomy, and the fistula was excised with a segment of adjacent lung tissue. Postoperative bronchoscopy revealed tracheobronchial stenosis and left main bronchial malacia, which were managed conservatively. Genetic testing identified PAI-1/SERPINE1 and MTHFR variants, but these did not establish a recognised syndrome or causal association with the fistula. The postoperative respiratory course was favourable. At 18 months of age, the child had no recurrent pneumothorax, chronic respiratory symptoms, or late surgical complications. Conclusion: Persistent high volume air leakage despite adequate pleural drainage should lead to suspect a major bronchial lesion and investigate congenital pulmonary and airway malformations. Conservative and bronchoscopic strategies may be effective in selected stable patients, whereas early surgery may provide definitive control in rapidly deteriorating neonates with a localised structural lesion. This case highlights the diagnostic value of CT, the need for individualised treatment selection, and the possibility of sustained long-term recovery after surgical repair.

Congenital chest wall deformities encompass a broad spectrum of anomalies, from the common pectus excavatum and pectus carinatum to rare, life-threatening conditions such as sternal clefts, ectopia cordis, pentalogy of Cantrell, and asphyxiating thoracic dystrophy (Jeune syndrome). This narrative review synthesizes current evidence on their epidemiology and pathogenesis, genetics and syndromic associations, diagnostic assessment, and the full range of conservative and surgical management, with particular attention to developments of the past decade. Pectus deformities affect roughly 1% of children, and although familial clustering supports a genetic contribution, no single causative gene has been established; syndromic associations, especially connective-tissue disorders, remain clinically actionable and warrant cardiovascular surveillance. Conservative treatment has become first-line for suitable patients: the vacuum bell for pectus excavatum and dynamic compression bracing for pectus carinatum both achieve good results when compliance is maintained. Minimally invasive repair remains the surgical standard for pectus excavatum, complemented by the modified Ravitch and hybrid procedures for complex morphology, while emerging innovations and enhanced-recovery protocols continue to improve safety and recovery. The rarer midline and chondrodysplastic deformities demand individualized, often emergency, multidisciplinary care. Across the spectrum, the most reproducible benefit of treatment lies in body image, self-esteem and quality of life, whereas a generalizable cardiopulmonary benefit remains unproven. Management should be individualized to the deformity, the child’s physiology, and the psychosocial burden of disease.

Introduction: The gold standard for the surgical treatment of pleural effusion is pleural drainage using video-assisted thoracoscopy (VATS). Intraoperative intercostal nerve cryoanalgesia may be a solution to reduce both the supply of analgesics, including opioids, and hospitalisation time. Aim: The aim of the study was to describe the use of cryoanalgesia for better pain control during pleural drainage in the course of pneumonia complicated by pleural effusion. Case study: A 6-year-old male patient was admitted to the Department of Paediatric Surgery for treatment of pleural empyema in the course of pneumonia. After no regression of the pleural lesions, the patient was qualified for surgical treatment. Pleural drainage uduring VATS and intraoperative intercostal nerve cryoanalgesia was performed. The mean numerous rating scale of pain (NRS) score during the first 5 days after drain insertion was 4, 4, 3, 3, 2 points. The only pharmacological drug used in postoperative pain treatment was paracetamol and, on day 1, Nalbuphine. The patient was discharged from hospital after 1 week. No complications after the procedure were noted. Results and discussion: The standard treatment for pneumonia complicated by effusion is a prolonged course of intravenous antibiotic therapy as a first-line treatment, but most patients can be treated with pleural drainage using VATS to remove the fibrin surrounding the lung. Intraoperative intercostal nerve cryoanalgesia can support analgesic treatment during pleural drainage and also reduces the number of adverse reactions occurring when opioids are used. Conclusions: Intraoperative intercostal nerve cryoanalgesia is a safe method for patients requiring pleural drainage during the VATS procedure. Performing VATS-guided pleural drainage is a safe and effective method for treating pleural empyema.