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[Long-term outcome of pectus excavatum surgically treated in children]
R Jawish1, P Rigault, J P Padovani
1Service d'Orthopédie-Traumatologie Infantile, Hôpital des Enfants Malades, Paris.
Insights
Sternochondroplasty offers superior long-term results for pectus excavatum compared to Judet's procedure. Optimal outcomes are achieved with sternochondroplasty in patients over 14, using robust fixation.
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Surgical outcomes
Context:
- Pectus excavatum is a congenital chest wall deformity.
- Surgical correction is often necessary for functional and aesthetic reasons.
- Comparing different surgical techniques is crucial for optimizing patient care.
Purpose:
- To evaluate and compare the long-term efficacy of two surgical methods for pectus excavatum correction: Judet's procedure and sternochondroplasty.
- To identify factors influencing surgical success and failure rates.
Summary:
- A study followed 34 pectus excavatum patients treated with either Judet's procedure (35% good results) or sternochondroplasty (88% good results).
- Early failures in Judet's procedure were linked to non-union and infection. Later failures related to patient age and fixation issues.
- Sternochondroplasty, particularly in patients over 14 with robust, long-term fixation, demonstrated durable correction without regression.
Impact:
- Sternochondroplasty is a more effective surgical approach for pectus excavatum, yielding higher success rates and fewer complications.
- Optimal surgical timing (over 14 years) and fixation techniques are critical for achieving lasting results.
- Understanding failure modes informs improved surgical strategies for pectus excavatum.
Abstract:
The authors have studied the result of 34 pectus excavatum, corrected by two surgical methods, followed up between 3 and 20 years: half of cases were treated by Judet's procedure, making turn over of anterior wall chest, with 35 per cent of good result. The other cases were treated by sternochondroplasty and internal fixation, with 88 per cent of good result. Early failures related to sternal non union and to infection, occurred in 53 per cent of Judet's procedure; eight of the 13 failures were managed by sternochondroplasty (7 cases) and Judet's procedure (1 case); followed by good results. Failure at further time was related to the young age of the patients at treatment, to the deficiency of fixation and early removal of material. Consequently, durable correction at long term was obtained, when treatment was performed by sternochondroplasty procedure, over 14 years of age, when many pins were used for fixing the correction, left in place for more than one year. In such cases, we didn't observe regression of result. When small residual deformities subsisted they were often masked by the development of the muscles in man, and breast in woman, providing acceptable aspect of chest.