Recent experience with surgical treatment for pectus excavatum

Background:

Pectus excavatum (PE) is one of the most common congenital chest wall deformities. Depending on the severity, presentation of PE may range from minor cosmetic issues to disabling cardiopulmonary symptoms. In symmetric PE minimal invasive correction using the Nuss technique is the current standard, however in more complex cases an open approach may be required.

Material and Method:

Between 2009 and 2018 36 patients with PE underwent primary surgery for PE in our center. Nuss procedure was performed in 33 (92%) cases. All operations were done in general anesthesia. Data regarding preoperative symptoms, type of operation, complications, satisfaction and follow up was analyzed.

Result:

32 (89%) male and 4 (11%) female patients were included in the study with a median age of 19 years (range 14 – 40). One patient underwent combined bilateral lung transplantation and PE repair. In 13 (36%) patients severe cardiorespiratory symptoms were present and an additional 11 (31%) patients experienced limitations in physical exercise. 11 (31%) patients had asymmetric PE. Median Haller-index was 4.05 (range 3.1 to 6.7). 27 patients (75%) received one bar during the operations. The most frequent postoperative complication was pneumothorax (n = 9, 25%) and 5 additional patients had minor postoperative complications (14%). Perioperative mortality was 0%. 14 patients (39%) received chest drainages. Reoperation was needed in 4 cases (11%). Median hospital stay was 8 days (range 5 – 26). The median time until bar removal was 28 months (range 9 to 56). Thirty patients (83%) reported a subjective satisfaction with the postoperative result.

Conclusion:

Pectus excavatum deformities can be repaired with no mortality, acceptable morbidity, very good cosmetic and subjective results and improvement in cardiological and respiratory symptoms.