Pectus excavatum: special surgical technique, perioperative management andlong-term results

Background; It is generally accepted that pectus excavatum should be repair ed in childhood if possible, The procedure could be performed conveniently even without implantation of any foreign material, In contrast there are se veral adult patients with aesthenic or marfanoid habitus and poor thorax co smetics, who seek medical help especially surgical correction due to late a wareness or cardiopulmonary dysfunction, Methods. Between 1989 and 1997, 22 adult patients (mean age 26 years, 18 ma les and 4 females) underwent repair of the pectus excavatum in our institut ion Patients data were analysed retrospectively. Indication was mainly for aesthetics or cardiopulmonary symptoms, in 3 patients for recurrence after primary repair elsewhere, The total surgical repair technique consisted of V-shape osteotomy of the ribs at the outer and inner limit of the funnel an d transverse osteotomy of the sternum without displacement of the posterior cortical. The sternal and chest wall stabilization in corrected position w as performed with at least two metal struts installed transsternal and tran sversely. In most of our cases other diagonal struts on both sides were nee ded to achieve further stabilization of the lowest costal cartilages, The m etal struts are removed 1 year after the procedure. Results, All repairs were completed with a low complication rate. Chest rad iographs and pulmonary function studies were performed routinely before and after corrective surgery. Good to satisfactory chest contour was achieved in 20 patients (91%), with a follow-up from 5 months to 8 years, Conclusions. Our current technique with perioperative management is success fully performed in adults and will be presented.