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Minimally invasive repair of pectus excavatum (MIRPE)--the Basel experience
F M Haecker1, J Bielek, D von Schweinitz
1Department of Paediatric Surgery, University Children's Hospital Basle, Switzerland. frankmartin.haecker@ukbb.ch
Purpose:
Minimally invasive repair of pectus excavatum (MIRPE) was first reported in 1998 by D. Nuss. This technique has gained wide acceptance during the last 4-5 years. In the meantime, some modifications of the technique have been introduced by different authors. Our retrospective study reports our own experience over the last 36 months and modifications introduced due to a number of complications.
Methods:
From 3/2000 to 3/2003, 22 patients underwent MIRPE. Patients median age was 15.5 years (10.7 to 20.3 years). Standardised preoperative evaluation included 3D computerised tomography (CT) scan, pulmonary function tests, cardiac evaluation with electrocardiogram and echocardiography, and photo documentation. Indications for operation included at least two of the following: Haller CT index > 3.2, restrictive lung disease, cardiac compression, progression of the deformity and severe psychological alterations.
Results:
In 22 patients (2 girls, 20 boys) undergoing MIRPE procedure, a single bar was used in 21 patients and two bars in one boy. Lateral stabilisers were fixed with non resorbable sutures on both sides. Overall, postoperative complications occurred in six patients (27.3%). In two patients (9.1%) a redo-procedure was necessary due to bar displacement. An additional median skin incision was performed in two patients to elevate the sternum. Pneumothorax or hematothorax in two patients resulted in routine use of a chest tube on both sides. Long-term favourable results were noted in all patients.
Conclusions:
The MIRPE procedure is an effective method with elegant cosmetic results. Modifications of the original method help to decrease the complication rate and to accelerate acquirement of expertise.
Insights
Minimally invasive repair of pectus excavatum (MIRPE) offers effective treatment with good cosmetic outcomes. Modifications to the Nuss procedure can reduce complications and improve surgical expertise for pectus excavatum repair.
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Minimally invasive procedures
Background:
- Minimally invasive repair of pectus excavatum (MIRPE), pioneered by D. Nuss in 1998, has gained significant acceptance.
- Recent years have seen various modifications to the original MIRPE technique by different surgical teams.
Purpose of the Study:
- To report the authors' 36-month experience with MIRPE.
- To detail modifications implemented to address observed complications.
Main Methods:
- A retrospective study of 22 patients (median age 15.5 years) who underwent MIRPE between March 2000 and March 2003.
- Preoperative evaluation included 3D CT scans, pulmonary function tests, cardiac assessments, and photographic documentation.
- Indications for surgery involved Haller CT index > 3.2, restrictive lung disease, cardiac compression, deformity progression, or psychological distress.
Main Results:
- 22 patients (2 female, 20 male) underwent MIRPE, with 21 receiving a single bar and one receiving two bars.
- Postoperative complications occurred in 6 patients (27.3%), including bar displacement (9.1%) requiring reoperation in two cases.
- Two patients needed sternal elevation via an additional incision. Pneumothorax/hemothorax in two patients led to bilateral chest tube use.
- All patients achieved favorable long-term results.
Conclusions:
- MIRPE is an effective surgical technique for pectus excavatum, yielding excellent cosmetic results.
- Modifications to the original Nuss procedure can effectively decrease complication rates.
- Implementing technique modifications aids in accelerating surgical expertise and improving patient outcomes.
