A 10-YEAR REVIEW OF A MINIMALLY INVASIVE TECHNIQUE FOR THE CORRECTIONOF PECTUS EXCAVATUM

Purpose: The aim of this study was to assess the results of a 10-year experience with a minimally invasive operation that requires neither c artilage incision nor resection for correction of pectus excavatum. Me thods: From 1987 to 1996, 148 patients were evaluated for chest wall d eformity. Fifty of 127 patients suffering from pectus excavatum were s elected for surgical correction. Eight older patients underwent the Ra vitch procedure, and 42 patients under age 15 were treated by the mini mally invasive technique. A convex steel bar is inserted under the ste rnum through small bilateral thoracic incisions. The steel bar is inse rted with the convexity facing posteriorly, and when it is in position , the bar is turned over, thereby correcting the deformity. After 2 ye ars, when permanent remolding has occurred, the bar is removed in an o utpatient procedure. Results: Of 42 patients who had the minimally inv asive procedure, 30 have undergone bar removal. Initial excellent resu lts were maintained in 22, good results in four,fair in two, and poor in two, with mean follow-up since surgery of 4.6 years (range, 1 to 9. 2 years). Mean follow-lip since bar removal is 2.8 years (range, 6 mon ths to 7 years). Average blood loss was 15 mL. Average length of hospi tal stay was 4.3 days. Patients returned to full activity after 1 mont h. Complications were pneumothorax in four patients, requiring thoraco stomy in one patient; superficial wound infection in one patient; and displacement of the steel bar requiring revision in two patients. The fair and poor results occurred early in the series because (1) the bar was too soft (th ree patients), (2) the sternum was too soft in one o f the patients with Marfan's syndrome, and (3) in one patient with com plex thoracic anomalies, the bar was removed too soon. Conclusions: Th is minimally invasive technique, which requires neither cartilage inci sion nor resection, is effective. Since increasing the strength of the steel bar and inserting two bars where necessary, we have had excelle nt long-term results. The upper limits of age for this procedure requi re further evaluation. Copyright (C) 1998 by W.B. Saunders Company.