Miniature access pectus excavatum repair: Lessons we have learned

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Medical Devices

Background:

• Pectus excavatum (PE) is the most common pediatric chest wall deformity.
• The Miniature Access Pectus Excavatum Repair (MAPER) was introduced in 1997 as a less invasive surgical option.
• This technique involves placing a custom bar to elevate the sternum and reshape cartilage.

Purpose of the Study:

• To present modifications to the original MAPER technique.
• To optimize surgical technique, reduce complications, and improve patient outcomes.
• To evaluate the efficacy and safety of the modified MAPER procedure.

Main Methods:

• Performed 52 MAPER procedures with an average operating time of 106 minutes.
• Included preoperative echocardiograms and pulmonary function tests (PFTs).
• Utilized unilateral positive pressure insufflation, thoracoscopy, epidural anesthesia, and surgical wire for bar fixation.

Main Results:

• Average length of stay was 3.9 days; return to activities took 2-6 weeks.
• No recurrences observed with bars in place for 3 years.
• Some patients required reoperation for bar-related issues.

Conclusions:

• Modified MAPER technique has evolved significantly since its introduction.
• The authors advocate for MAPER over open repair due to minimized complications and improved results.
• The modified MAPER procedure demonstrates superior outcomes in treating pediatric pectus excavatum.