Outcome analysis of minimally invasive repair of pectus excavatum: Review of 251 cases

Background/Purpose: Since the first report in 1997 by Dr Nuss of the techni que for minimally invasive repair of pectus excavatum (MIRPE), the populari ty and demand for this operation has increased dramatically. Many pediatric surgeons became familiarized with MIRPE and have applied it to a large num ber of patients. Outcomes and complications have not yet been defined. Methods: A comprehensive survey of APSA members was conducted to review tec hnical problems, complications, and outcomes of this new technique. Results: Of the 74 survey responders, 31 (42%) currently use the MIRPE as t heir procedure of choice, and 251 cases were reviewed. A total of 74.2% of surgeons relied on direct observation and written documentation to obtain t raining in MIRPE. Less than 60% used the chest index in the preoperative as sessment. A total of 98% used the Waiter Lore nz bar for the MIRPE. The mos t common complication was bar displacement or rotation requiring reoperatio n (9.2%). Pneumothorax requiring tube thoracostomy was reported in 4.8%. Le ss common problems included infectious complications (2%), pleural effusion (2%), thoracic outlet obstruction (0.8%), cardiac injury (0.4%), sternal e rosion (0.4%), pericarditis (0.4%), and anterior thoracic artery pseudoaneu rysm (0.4%). Three patients (1.2%) required early strut removal. Reoperatio n using the open modified Ravitch approach was performed in 2 patients (0.8 %). Most surgeons indicated that teenaged patients (>15 years old) were at higher risk for complications. Thoracoscopy in combination with MIRPE was u sed by 61% of the surgeons. Overall patient satisfaction was rated as excel lent or good (96.5%). Conclusions: The relatively high incidence of problems with MIRPE is probab ly related to the learning curve associated with the introduction of this n ew technique. Awareness of technical details, careful patient selection, us e of a stabilizing bar, and thoracoscopy likely will result in decreased co mplications. Long-term results are yet to be determined. The development of a national registry is of great importance for further outcome analysis of MIRPE. J Pediatr Surg 35:252-258. Copyright (C) 2000 by W.B. Saunders Comp any.