Minimally invasive repair of pectus excavatum

A novel morphology-tailored, patient-specific approach

Hyung Joo Park, Jin Yong Jeong, Won-Min Jo, Jae Seung Shin, In Sung Lee, Kwang Taik Kim, Young Ho Choi

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Objective: Minimally invasive repair of pectus excavatum, introduced by Nuss in 1998, has undergone a serious learning curve because of a lack of understanding on morphologies and repair techniques. To summarize the current status of minimally invasive repair of pectus excavatum, we reviewed and appraised our 10-year experience with a novel approach, a morphology-tailored technique, including diverse bar shaping, bar fixation, and techniques for adults. Methods: We analyzed the data of 1170 consecutive patients with pectus excavatum who underwent minimally invasive repair between August 1999 and September 2008. All pectus repairs were performed by the primary author (H.J.P.) with our modified technique. Results: The mean age was 10.3 years (range, 16 months to 51 years). There were 331 adult patients (>15 years) (28.3%). A total of 576 patients (49.2%) had bar removal after a mean of 2.5 years (range, 10 days to 7 years). The asymmetry index change (1.10-1.02, P < .001) demonstrated post-repair symmetry. Complication rates decreased through the 3 time periods (1999-2002 [n = 335]; 2003-2005 [n = 441]; 2006-2008 [n = 394]) as follows: pneumothorax rate (7.5% vs 4.3% vs 0.8%; P < .001) and bar displacement rate (3.8% vs 2.3% vs 0.5%; P = .002). Reoperation rate also decreased (4.8% vs 2.5% vs 0.8%; P = .002). Satisfaction outcomes were excellent in 92.7%, good in 5.9%, and fair in 1.4% of patients. After bar removal, 3 patients (0.6%) had minor recurrences. Conclusion: Minimally invasive repair of pectus excavatum based on a novel morphology-tailored, patient-specific approach is effective for quality repair of the full spectrum of pectus excavatum, including asymmetry and adult patients. Continuous technical refinements have significantly decreased the complication rates and postoperative morbidity.

Original languageEnglish
Pages (from-to)379-386
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume139
Issue number2
DOIs
Publication statusPublished - 2010 Feb 1

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Funnel Chest
Learning Curve
Pneumothorax
Reoperation
Morbidity
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Minimally invasive repair of pectus excavatum : A novel morphology-tailored, patient-specific approach. / Park, Hyung Joo; Jeong, Jin Yong; Jo, Won-Min; Shin, Jae Seung; Lee, In Sung; Kim, Kwang Taik; Choi, Young Ho.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 139, No. 2, 01.02.2010, p. 379-386.

Research output: Contribution to journalArticle

Park, Hyung Joo ; Jeong, Jin Yong ; Jo, Won-Min ; Shin, Jae Seung ; Lee, In Sung ; Kim, Kwang Taik ; Choi, Young Ho. / Minimally invasive repair of pectus excavatum : A novel morphology-tailored, patient-specific approach. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 139, No. 2. pp. 379-386.
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abstract = "Objective: Minimally invasive repair of pectus excavatum, introduced by Nuss in 1998, has undergone a serious learning curve because of a lack of understanding on morphologies and repair techniques. To summarize the current status of minimally invasive repair of pectus excavatum, we reviewed and appraised our 10-year experience with a novel approach, a morphology-tailored technique, including diverse bar shaping, bar fixation, and techniques for adults. Methods: We analyzed the data of 1170 consecutive patients with pectus excavatum who underwent minimally invasive repair between August 1999 and September 2008. All pectus repairs were performed by the primary author (H.J.P.) with our modified technique. Results: The mean age was 10.3 years (range, 16 months to 51 years). There were 331 adult patients (>15 years) (28.3{\%}). A total of 576 patients (49.2{\%}) had bar removal after a mean of 2.5 years (range, 10 days to 7 years). The asymmetry index change (1.10-1.02, P < .001) demonstrated post-repair symmetry. Complication rates decreased through the 3 time periods (1999-2002 [n = 335]; 2003-2005 [n = 441]; 2006-2008 [n = 394]) as follows: pneumothorax rate (7.5{\%} vs 4.3{\%} vs 0.8{\%}; P < .001) and bar displacement rate (3.8{\%} vs 2.3{\%} vs 0.5{\%}; P = .002). Reoperation rate also decreased (4.8{\%} vs 2.5{\%} vs 0.8{\%}; P = .002). Satisfaction outcomes were excellent in 92.7{\%}, good in 5.9{\%}, and fair in 1.4{\%} of patients. After bar removal, 3 patients (0.6{\%}) had minor recurrences. Conclusion: Minimally invasive repair of pectus excavatum based on a novel morphology-tailored, patient-specific approach is effective for quality repair of the full spectrum of pectus excavatum, including asymmetry and adult patients. Continuous technical refinements have significantly decreased the complication rates and postoperative morbidity.",
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