title: How early can we repair pectus excavatum: the earlier the better?
abstract: OBJECTIVE
  The optimal age for the repair of pectus excavatum using minimally invasive technique has yet to be determined. We hypothesized that the early repair of pectus excavatum may contribute in preserving chest wall integrity and also in enhancing patients' growth. The purpose of our present study was to verify a potential advantage of the early repair of pectus excavatum by using a minimally invasive technique.
  
  
  METHODS
  For our study on minimally invasive pectus excavatum repair, 1571 patients from the period 1999 to 2011 were enrolled. Our strategy was to carry out routine repairs in patients older than 3 years of age. To examine the age factor on the results of the repairs the patients were divided into different age groups: Group 1 (≤ 5 years, 618 (39.3%)), Group 2 (6-11 years, 322 (20.5%)), Group 3 (12-20 years, 401 (25.5%)) and Group 4 (>20 years, 230 (14.6%)). A comparative analysis was performed for factors such as complication rates; growth-percentile scores of height, weight and body mass index (BMI); incidence of asymmetry and costal flare score to determine the potential to resume the normal chest wall conformation by earlier repair.
  
  
  RESULTS
  The mean age of the patients was 10.2 years (16 months to 51 years). The incidence of asymmetry was found to be lowest in Group 1 (24.3, 45.5, 58.7, 48.4%, respectively, P < 0.001). The complication rate after repair was also lowest in Group 1 (7.6, 11.5, 16.3, 19.1%, respectively, P < 0.001). The growth of body weight was significant in Groups 1 and 2 (0.53 ± 1.02, P < 0.001). The costal flare score was found to have decreased in Groups 1 and 2 (Group 1: from 1.6 to 0.12, P < 0.001; Group 2: from 1.44 to 0.14, P < 0.001). In Groups 3 and 4, there was no improvement in costal flare after repair.
  
  
  CONCLUSIONS
  Our results suggest that routine early repair of pectus excavatum in patients older than 3 years of age is safe and effective. We would recommend early repair to avoid asymmetry transformation of the deformity and to enhance the patients' growth potential.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Korea. hyjpark@catholic.ac.kr
authors.forename: Hyung Joo
authors.initials: HJ
authors.lastname: Park
authors.forename: Sook-Whan
authors.initials: SW
authors.lastname: Sung
authors.forename: Jae-Kil
authors.initials: JK
authors.lastname: Park
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Kim
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Jeon
authors.forename: Young-Pil
authors.initials: YP
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D015430:Weight Gain; D055815:Young Adult