Self and parental assessment after minimally invasive repair of pectus excavatum: lasting satisfaction after bar removal.
BACKGROUND
Improvement of quality of life by minimally invasive repair of pectus excavatum (MIRPE) has been demonstrated only for the period with implanted pectus bar. The aim of this study was to demonstrate the effects of MIRPE on psychosocial and physical well-being after removal of the pectus bar.


METHODS
Forty patients (26 boys and 14 girls; mean age, 17 years; range, 10 to 24 years) were assessed. Follow-up was performed for a mean of 54 months after pectus repair (range, 25 to 73 months). Patients were interviewed at 6 months after MIRPE with the bar in place, and patients and parents were assessed a mean of 23 months after bar removal (range, 2 to 48 months). A single-step questionnaire that evaluates psychosocial and physical well-being was independently used by patients and their parents.


RESULTS
There was a high level of persistent satisfaction with MIRPE after bar removal (mean total score = 67; maximal score = 80) and a highly significant correlation between self and external assessment (p < 0.001; Spearman correlation coefficient = 0.77). Analysis of specific and total scores revealed a significant improvement of psychosocial and physical well-being after bar implantation, which persisted up to 4 years after bar removal (p < 0.001). Age and sex had no significant impact on the mean specific and total scores either in patients or in parents. Persistent pectus excavatum was noticed in 1 patient after bar removal (2.5%) as a result of treatment failure.


CONCLUSIONS
The positive impact of MIRPE on psychosocial and physical well-being in children and adolescents persists after bar removal. Thus we consider MIRPE to be justified for cosmetic reasons.
Metzelder
Martin L
ML
Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. mmetzelder@yahoo.com
Kuebler
Joachim F
JF
Leonhardt
Johannes
J
Ure
Benno M
BM
Petersen
Claus
C
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010149:Postoperative Pain; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D011788:Quality of Life; D012647:Self-Assessment; D012737:Sex Factors; D016896:Treatment Outcome