Hybrid Technique for Repair of Recurrent Pectus Excavatum After Failed Open Repair.
BACKGROUND
Successful repair of recurrent pectus excavatum (PE) after failed open procedure has been reported using minimally invasive repair (MIRPE) and open approaches. Neither approach alone may be adequate for some patients. A hybrid technique for repair is presented for revision of recurrent PE.


METHODS
A retrospective review of adults undergoing repair for recurrent PE after prior open repair from January 2010 to June 2014 was performed.


RESULTS
Seventy-three adult patients underwent repair for recurrent PE, with 48 patients (65.8%) undergoing repair for recurrence after at least one prior open PE repair. Mean patient age was 34.5 years (range, 19 to 54 years); mean Haller index was 4.7 (range, 2.8 to 14.7). Fourteen (29%) recurrences with adequate chest wall pliability and no malunion were repaired with MIRPE alone; 34 patients (71%) underwent a hybrid procedure for repair (20 for PE recurrence alone; 14 for PE with acquired thoracic dystrophy). All had at least two support bars placed, and 11 patients (23%) had three bars placed. Mean hospitalization for MIRPE was 5 days, for hybrid was 7 days, and for hybrid because of acquired thoracic dystrophy was 10 days. One patient died of unexpected out-of-hospital arrest; there was one emergent conversion to open sternotomy for bleeding.


CONCLUSIONS
Most recurrent PE may be repaired with excellent results and minimal complications. Those with adequate chest pliability and no malunion are candidates for MIPRE alone. A hybrid procedure with thoracoscopic support bars combined with sternal elevation, multiple open osteotomies, and chest wall fixation is appropriate for recurrences associated with malunion or fixation of the anterior chest and failure to lift with MIRPE.
Division of General Surgery, Mayo Clinic, Arizona.
Kevin N
KN
Johnson
Division of Cardiothoracic Surgery, Mayo Clinic, Arizona. Electronic address: jaroszewski.dawn@mayo.edu.
Dawn E
DE
Jaroszewski
Division of Cardiothoracic Surgery, Mayo Clinic, Arizona.
MennatAllah
M
Ewais
Division of Cardiothoracic Surgery, Mayo Clinic, Arizona.
Jesse J
JJ
Lackey
Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona.
Lisa
L
McMahon
Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona.
David M
DM
Notrica
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D035441:Thoracic Wall / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult