Modified Robicsek procedure for pectus excavatum in adult patients.
OBJECTIVE
The aim of this study was to clarify the short-term and mid-term outcomes of the modified Robicsek procedure using polypropylene mesh for adult pectus excavatum patients.


METHODS
Retrospective chart review was performed. Between 2001 and 2012, 46 consecutive adult patients underwent modified Ravitch repair using polypropylene mesh for pectus excavatum at our institution. There were 30 males and 16 females, with a median age of 25.5 (range: from 17 to 60). Potential risk factors for perioperative complications and early failure in pectus repair were analysed with χ(2) test or Fisher's exact test and Mann-Whitney test. Potential risk factors for postoperative mid-term recurrence were analysed using Cox proportional hazard regression model.


RESULTS
The postoperative follow-up interval was 7.0 ± 15.1 months (mean ± standard deviation). No mortality and 11 patients (24.0%) of morbidity, including 2 patients with temporary mesh infection, were noted. A lower preoperative %FEV1.0 predicted was a significant factor (P = 0.0088) of morbidity in multivariate analysis. Regarding chest morphology, early failure in 1 patient (2.2%) and mid-term recurrence in 1 patient (2.2%) were seen. Previous pectus repair (P = 0.0324) and severe asymmetry (P = 0.04) were significant factors of early failure in multivariate analysis, while no significant factor for mid-term recurrence was found.


CONCLUSIONS
Modified Robicsek procedure with a polypropylene mesh is associated with low incidences of early failure and mid-term recurrence. The procedure is recommended for adult pectus excavatum patients, including those with asymmetric or combined deformity as an initial or reoperative procedure.
Division of General Thoracic Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
Masatsugu
M
Hamaji
Kei
K
Hiraoka
Dawn E
DE
Jaroszewski
Claude
C
Deschamps
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D005660:Funnel Chest / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011126:Polypropylenes; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
D011126:Polypropylenes
Adult; Pectus; Surgery