Surgical repair of recurrent pectus excavatum in adults and adolescents


Authors: M. Lučenič ;  M. Janík ;  R. Benej ;  A. Garchar ;  P. Juhos
Authors‘ workplace: Klinika hrudníkovej chirurgie SZU a UN Bratislava, Slovenská republika, prednosta: prof. MUDr. S. Haruštiak, CSc.
Published in: Rozhl. Chir., 2015, roč. 94, č. 3, s. 111-116.
Category: Original articles

Overview

Introduction:
Recurrent pectus excavatum is the most serious late complication after primary repair. Redo open repair (Highly Modified Ravitch Repair, HMRR) or minimally invasive repair of pectus excavatum (MIRPE) are usually performed in indicated cases. This paper focuses on the evaluation of available redo surgical techniques in adult and adolescent patients with recurrent pectus excavatum.

Methods:
126 operative corrections, predominantly in adult patients, were performed by the authors between June 2006 and October 2014. HMRR was the method of choice in 51 cases, and MIRPE in 75 cases. Recurrent pectus excavatum was the indication in 12 repair procedures (9.5%) in 11 patients. Prior repairs included HMRR in 10 patients and MIRPE in one case. Both HMRR and MIRPE were indicated as redo procedure in six cases. The median age in the redo group was 23.5 (17−44) years and the median interval between the primary correction and the redo procedure was 9.5 (2−31) years. The male to female ratio was 3:1.

Results:
The use of MIRPE resulted in shorter operation time (120 vs. 172 min). There was no difference in the length of postoperative hospitalisation. Three complications (50%) were recorded in the HMRR group (wound seroma, intrapericardial bar migration with hemopericardium, displaced rectus abdominis muscle) and one (16.7%) occurred in the MIRPE group (symptomatic fluidothorax).

Conclusion:
Despite our limited experience with both techniques in the treatment of recurrent pectus excavatum we believe that MIRPE should be regarded as a safe and effective technique for the redo repair in adolescent and adult patients.

Key words:
HMRR – MIRPE − recurrent pectus excavatum


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Labels
Surgery Orthopaedics Trauma surgery
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