Initial results with minimally invasive repair of pectus carinatum.
OBJECTIVE
Pectus carinatum is traditionally repaired by using some modification of the open Ravitch procedure, with its possible long-term sequelae, such as poor postoperative compliance of the chest. In this study we assessed our results with a new minimally invasive repair of pectus carinatum that requires neither cartilage incision nor sternotomy.


METHODS
From June 2005, we have corrected pectus carinatum using a method analogous to the Nuss procedure for pectus excavatum repair. Thus far, we performed this intervention on 14 patients (mean age, 15 +/- 1.5 years). A steel bar has been inserted at the level of the maximum point of the sternal protrusion through small lateral incisions. The sternum is pushed back without osteotomy or chondrotomy. The bar is removed after 2 years. Patients' characteristics, operation time, hospital stay, and complications have been recorded.


RESULTS
In 1 patient with asymmetric deformity, 2 bars were placed. Operative time was 42 +/- 20 minutes (mean +/- standard deviation), and hospital stay was 3 days (median quartiles, 3-4 days) postoperatively. We experienced lateral shift of the bar in 1 patient, which was treated with remodeling and repositioning of the bar. No other complication occurred during the 18-month follow-up period (mean range, 2-38 months). Thirteen of the 14 patients reported excellent or very good results. Patients returned to full activity within 2 months. Five bars have been removed.


CONCLUSIONS
Minimally invasive repair of pectus carinatum leaves the integrity of the chest wall untouched. It is safe with a short operative time and hospital stay and provides good results, even in asymmetric cases.
Kálmán
Attila
A
First Department of Pediatrics, Semmelweis University, Budapest, Hungary. ka@gyer1.sote.hu
D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures; D013249:Sternum / Q000002:abnormalities* / Q000601:surgery*