Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach.
OBJECTIVE
Minimally invasive repair of pectus excavatum, introduced by Nuss in 1998, has undergone a serious learning curve because of a lack of understanding on morphologies and repair techniques. To summarize the current status of minimally invasive repair of pectus excavatum, we reviewed and appraised our 10-year experience with a novel approach, a morphology-tailored technique, including diverse bar shaping, bar fixation, and techniques for adults.


METHODS
We analyzed the data of 1170 consecutive patients with pectus excavatum who underwent minimally invasive repair between August 1999 and September 2008. All pectus repairs were performed by the primary author (H.J.P.) with our modified technique.


RESULTS
The mean age was 10.3 years (range, 16 months to 51 years). There were 331 adult patients (>15 years) (28.3%). A total of 576 patients (49.2%) had bar removal after a mean of 2.5 years (range, 10 days to 7 years). The asymmetry index change (1.10-1.02, P < .001) demonstrated post-repair symmetry. Complication rates decreased through the 3 time periods (1999-2002 [n = 335]; 2003-2005 [n = 441]; 2006-2008 [n = 394]) as follows: pneumothorax rate (7.5% vs 4.3% vs 0.8%; P < .001) and bar displacement rate (3.8% vs 2.3% vs 0.5%; P = .002). Reoperation rate also decreased (4.8% vs 2.5% vs 0.8%; P = .002). Satisfaction outcomes were excellent in 92.7%, good in 5.9%, and fair in 1.4% of patients. After bar removal, 3 patients (0.6%) had minor recurrences.


CONCLUSIONS
Minimally invasive repair of pectus excavatum based on a novel morphology-tailored, patient-specific approach is effective for quality repair of the full spectrum of pectus excavatum, including asymmetry and adult patients. Continuous technical refinements have significantly decreased the complication rates and postoperative morbidity.
Park
Hyung Joo
HJ
Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Ansan, Korea. hyjpark@korea.ac.kr
Jeong
Jin Yong
JY
Jo
Won Min
WM
Shin
Jae Seung
JS
Lee
In Sung
IS
Kim
Kwang Taik
KT
Choi
Young Ho
YH
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D017060:Patient Satisfaction; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D019736:Prostheses and Implants; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods; D055815:Young Adult