Abstract
Background
Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication
between the pleural cavities, known as a “buffalo chest.” Patients with pectus excavatum
are also at increased risk of spontaneous pneumothorax due to congenital apical blebs.
When these two conditions coexist, the risk of bilateral spontaneous pneumothorax
becomes potentially life-threatening. This study aims to evaluate the incidence and
characteristics of spontaneous pneumothorax following MIRPE, with particular attention
to the presence and role of congenital blebs.
Methods
We retrospectively reviewed patients who underwent MIRPE between 2005 and 2024 to
identify cases of spontaneous pneumothorax. Only cases occurring at least 1 month
postoperatively and unrelated to intraoperative thoracoscopy were included. Patients
were followed for at least 10 months. We analyzed laterality, clinical presentation,
presence of blebs, treatment, and outcomes. A systematic literature review was also
conducted to explore the relationship between buffalo chest, pneumothorax, and pectus
excavatum.
Results
Among 795 patients, 7 developed spontaneous pneumothorax: 4 unilateral, 3 bilateral.
In six cases, blebs were identified and treated with thoracoscopic bullectomy and
pleurodesis. Two patients with bilateral pneumothorax experienced cardiac arrest:
one recovered after emergency drainage; the other died in a peripheral hospital, where
blebs were suspected but not confirmed. The literature review identified nine similar
cases in five reports.
Conclusion
Bilateral spontaneous pneumothorax after MIRPE can be a life-threatening emergency
due to the buffalo chest. Patients and families should be informed of this rare but
serious risk to enable early recognition and prompt treatment. Preoperative detection
of apical blebs may help reduce this risk.
Keywords
pectus excavatum - carinatum - pneumothorax - pleural disease (incl. drainage) - chest
wall - minimally invasive surgery (includes port access minithoracotomy) - pediatric
