Minimally invasive repair of pectus excavatum - shifting the paradigm?
C Petersen1, J Leonhardt, M Duderstadt
1Department of Paediatric Surgery, Medical School Hannover, Hannover, Germany. petersen.claus@mh-hannover.de
Purpose:
The "minimally invasive repair of pectus excavatum" (MIRPE) has increasingly become the standard operation for the repair of pectus excavatum. The aim of the present study was to report on our first-line postoperative results, including a survey of patients and to elucidate the acceptance of MIRPE.
Patients And Methods:
All MIRPE patients, who were operated on between 2000 and 2004 in our departments, were included in a retrospective study. In 2002, a retrospective questioning of 57 patients was initiated by sending identical questionnaires separately to both the patients and their parents asking for individual reasons for choosing and/or agreeing to MIRPE.
Results:
Complications were seen in 25 out of 84 MIRPE patients (mean 14 years, range from 5 to 20 years), but most of them were minor. Removal of the bar was necessary in 6 cases, due to bar displacement, secondary haematothorax, pericardial effusion, and local infection, respectively. No major complications occurred in the age group between 9 and 14 years. More than 90 % of the patients and their parents were satisfied or highly satisfied with the MIRPE procedure.
Conclusion:
General and specific complications are similar to other series and they decrease with the surgeon's experience. The most severe problem, occurring in older patients, is how to avoid dislocation of the pectus bar. In the light of the complication rate, the acceptance of MIRPE is still high, especially in adolescents and young adults who had refused operation with the open techniques. In this way, a shifting of a paradigm is taking place.
Insights
Minimally invasive repair of pectus excavatum (MIRPE) shows high patient satisfaction. While complications can occur, they are generally minor and decrease with surgeon experience, indicating MIRPE
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Minimally invasive surgery
Background:
- Minimally invasive repair of pectus excavatum (MIRPE) is increasingly the standard surgical approach.
- Pectus excavatum repair outcomes and patient acceptance require ongoing evaluation.
Purpose of the Study:
- To report initial postoperative results of MIRPE.
- To assess patient and parental acceptance of the MIRPE procedure.
Main Methods:
- Retrospective study of 84 patients undergoing MIRPE between 2000-2004.
- Patient and parental questionnaires administered in 2002 to ascertain reasons for choosing MIRPE.
Main Results:
- Complications occurred in 25/84 patients, mostly minor; 6 required bar removal.
- No major complications were observed in patients aged 9-14 years.
- Over 90% of patients and parents reported high satisfaction with MIRPE.
Conclusions:
- MIRPE complication rates are comparable to other series and decrease with surgical experience.
- Pectus bar dislocation is a concern, particularly in older patients.
- MIRPE demonstrates high acceptance, especially among adolescents and young adults, signaling a paradigm shift in pectus excavatum repair.
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