Minimally invasive repair of pectus excavatum in adults: a single centre experience based characteristics

Background:

Pectus excavatum (PE) is the most common anomaly of the anterior chest wall. Many modifications of traditional sternochondroplasty for PE correction have been developed over the last decades. Since the minimally invasive Nuss technique was described in 1998, it has been preferred by majority of surgeons.

Methods:

Modified Nuss procedure for PE-correction has been performed since 2008 at our Thoracic Surgery Department. Between 2008 and 2019, 367 PE-patients were evaluated however, only 139 (37%) received surgery. The median age was 20 ± 8 years. All patients had preoperatively a patient controlled analgesia (PCA) epidural catheter. Postoperative analgesia was scheduled for 4 – 5 weeks. Routine follow up occurred 2 weeks, 6 months and then once yearly after surgery. Bars were removed 3.5 ± 0.9 years (median 3.65) after surgery.

Results:

Sixty (43%) patients received one bar, 75 (53%) patients received 2 bars, and 4 (3%) patients received 3 bars. Median length of the implanted bar was 13 ± 2 inch. Median operating time was 80 ± 25 minutes. Median postoperative hospital stay was 5 ± 3 days. No deaths or severe infections occurred. Ten (7%) patients experienced complications: 4 bar dislocations, 5 pneumothorax requiring chest drainage; 1 bar stabilizer removal due to severe pain was necessary.

Conclusions:

Due to restrictive German health insurance regulations only a low number of PE-patients received surgical correction. Over the time shorter bars have increasingly been used. Shorter bars implantation provides better stability, good cosmetic result, better chest wall dynamics and is associated with reduced complication ratio.