The surgical treatment of pectus excavatum: an experience with 90 operations

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric=0-21; adult 17-99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation.

Correction of pectus excavatum with a self-retaining seagull wing prosthesis. Long-term follow-up

Between June 1958 and December 1991, 315 patients (217 male and 98 female, mean age = 17.8 +/- 5.5 years) affected by pectus excavatum (PE) were surgically treated. Most of the patients required operation for aesthetic reasons only (299 patients; 95 percent). The grade of PE (Chin classification) was I in 72 patients, II in 152, and III in the remaining 91. The surgical technique consisted of a double transversal sternotomy at the level of the lowest and highest part of the depression associated with a longitudinal sternotomy. A wedge resection of the ribs was then performed and the sternum was fixed using a stainless steel strut molded into a seagull wing prosthesis. The strut was removed 12 months postoperatively. There were no operative mortalities. Four patients had sternal wound infection that was successfully treated. The mean follow-up was 15.8 years per patient and was 60 percent complete. From the aesthetic point of view, the postoperative results were excellent in 246 patients (78 percent), good in 57 (18 percent), and poor in 12 (4 percent). All subjective symptoms, when present, disappeared after surgery. The seagull wing prosthesis appears to be safe, easy to implant and to remove, and comfortable for the patient. This technique has shown good long-term results independently of type of deformity and patient age.

An approach to the management of chest wall deformities

Chest wall deformities are seen frequently in children and adolescents. Fortunately, the deformity is usually mild and the only therapeutic requirement is patient and family reassurance. If the deformity is more severe, consideration must be given to surgical correction. Although sophisticated studies have shown that cardiopulmonary function may be limited by funnel chest, the findings are rarely of clinical significance and, therefore, with few exceptions, operations will be performed for cosmetic and/or psychological reasons. In order to be able to manage patients with chest wall deformities appropriately, clarity of thinking is essential in relation to classification, symptomatology and treatment options. Before reaching a final decision regarding operation, several interviews may be required. In order to assess the final result, long-term follow-up is mandatory.

Pectus excavatum and cardiac dysfunction: a case report with pre- and post-operative haemodynamic studies

A 48-year-old man with severe pectus excavatum presented with incapacitating supraventricular tachycardia, paroxysmal in nature and invariably provoked by exercise. During mild supine leg exercise on a bicycle ergometer an abnormal increase in right heart pressures, particularly in the right atrium, was observed, followed immediately by supraventricular tachycardia. The latter was also shown during upright exercise on a treadmill. Operative correction of the deformity led to complete relief from the dysrhythmia and a normal haemodynamic response on exercise. The pre- and post-operative studies lend support to the conclusion that the sternal depression was the most likely cause of the cardiac abnormality.