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Valuable lessons from two decades of pectus repair with the Willital-Hegemann procedure
Amulya K Saxena1, Gunter H Willital
1Department of Pediatric Surgery, Medical University of Graz, Graz, Austria. amulya.saxena@meduni-graz.at
Insights
This study shows that internal stabilization with stainless-steel struts is an effective surgical technique for pectus deformities, offering good cosmetic and physiologic results with low recurrence rates.
Area of Science:
- Thoracic surgery
- Congenital deformities
- Biomaterials in medicine
Background:
- Pectus deformities represent the most frequent congenital hereditary chest wall anomaly.
- Effective surgical correction is crucial for both functional and aesthetic outcomes.
Purpose of the Study:
- To evaluate the efficacy of thoracic wall reconstruction using stainless-steel struts for pectus deformities.
- To assess the outcomes and complication rates associated with this surgical technique.
Main Methods:
- A retrospective review of hospital charts for patients undergoing the Willital-Hegemann procedure between 1984 and 2004.
- Analysis of surgical success, recurrence rates, complication rates, and patient demographics.
Main Results:
- Successful repair was achieved in 98.6% of 1262 patients with pectus deformities.
- A low overall complication rate of 5.7% was observed, with strut removal having a 2.6% complication rate.
- Major and mild recurrences were reported in 1.4% and 3.6% of patients, respectively.
Conclusions:
- The stainless-steel strut technique allows for custom-tailored chest wall molding, superior to minimal-access methods.
- Open repair is effective across all pectus deformity variations and age groups, yielding good functional and cosmetic results with manageable pain.
- This procedure offers satisfactory long-term outcomes, improves subjective complaints and psychological issues, and should be considered for low-risk pediatric patients.
Objective:
Pectus deformities are the most common congenital hereditary chest wall deformity. The aim of this study was to evaluate the efficacy of thoracic wall reconstruction using a uniform technique of internal stabilization with stainless-steel struts.
Methods:
Hospital charts of patients with chest wall deformities managed with the Willital-Hegemann procedure between January 1984 and January 2004 were reviewed.
Results:
Surgical corrections were performed in 1262 patients with pectus deformities (968 male and 294 female patients). The corrections were completed with successful repair in 1244 (98.6%) patients, along with a low complication rate of 5.7%. The median age of the patients was 14.9 years (range, 2-53 years). The follow-up period ranged from 2 to 12 years (mean, 5.4 years). Major recurrences were observed in 18 (1.4%) patients, and mild recurrences were observed in 46 (3.6%) patients. There was 1 death in this series. The struts were removed after a period of 24 to 36 months and were associated with a complication rate of 2.6% at the time of removal.
Conclusion:
Custom-tailored molding of the chest wall can be achieved by using this method, which is not possible with minimal-access techniques. Open repair is effective for all variations of chest wall deformities and in patients of all ages, causes only mild pain, and produces good physiologic and cosmetic results. Improvement of subjective complaints, satisfactory long-term results, and improvement in psychological problems indicate the need to offer this procedure among other surgical correction options for low-risk children.
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