Surgical technique changes in the repair of pectus excavatum between 1991 and 2012


Authors: J. Šnajdauf 1;  M. Vyhnánek 1;  M. Rygl 1;  A. Kučera 1;  R. Fryč 1;  O. Petrů 1;  V. Mixa 2;  M. Kynčl 3
Authors‘ workplace: Klinika dětské chirurgie 2. LF UK a FN Motol, subkatedra dětské chirurgie IPVZ přednosta: Prof. MUDr. J. Šnajdauf, DrSc. 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny 2. LF UK a FN Motol přednosta: Prof. MUDr. K. Cvachovec, CSc. 2;  Klinika zobrazovacích metod 2. LF UK a FN Motol přednosta: Doc. MUDr. M. Roček, CSc. 3
Published in: Rozhl. Chir., 2013, roč. 92, č. 8, s. 429-434.
Category: Original articles

Overview

Introduction:
The aim of this article is a retrospective analysis of the results of three methods used for the repair of pectus excavatum between 1991 and 2012.

Material and methods:
508 patients were operated on at the Department of Paediatric Surgery of the Second Faculty of Medicine, Charles University, and the Teaching Hospital in Motol between 1991 and 2012. 16 patients were older than 19 years (19–28 years). The average age of paediatric and adolescent patients was 14.2 years (5–19 years range). Boys (408) prevailed over girls (82), the ratio being 4.9:1. Open Holcomb technique was used to operate on 87 patients (17%), the Welch method was applied in 208 patients (41%). Minimally invasive repair of pectus excavatum (MIRPE) was used in 213 patients (42%) during the entire period of time.

Results:
As for the 295 patients operated on by the open Holcomb and Welch method, the outcome was excellent in 239 (81%) of them. A favourable result with a small deformity remaining occurred in 44 patients (15%). Unfavourable result was found in 7 patients (2.5%): in these children, a deep excavation occurred 3–5 years postoperatively. In 5 patients (1.5%) we evaluated the result as recurrent chest wall deformity. The minimally invasive method (MIRPE) produced an excellent result in 182 out of 213 patients (85%). A favourable outcome was observed in 27 (22%), unfavourable result in 1 (0.5%) patient.

Conclusion:
In the last 15 years, minimally invasive repair of pectus excavatum has become popular worldwide. Due to very favourable cosmetic results and a relatively small, gradually decreasing number of complications, the proportion of patients requiring surgery to correct their deformity has risen sharply.

Key words:
Pectus excavatum – standard surgical techniques – minimally invasive repair of pectus excavatum – MIRPE


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Surgery Orthopaedics Trauma surgery
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