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Updated: Jul 5, 2026
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Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Extreme eccentric canal type pectus excavatum: morphological study and repair techniques
Hyung Joo Park1, In Sung Lee, Kwang Taik Kim
1Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Ansan Hospital, Ansan, South Korea. hyjpark@korea.ac.kr <hyjpark@korea.ac.kr>
Summary
Extreme eccentric canal type pectus excavatum, a challenging chest wall deformity, can be effectively repaired using specialized techniques. These methods achieve significant improvements in chest symmetry and depression, offering successful outcomes for patients.
Area of Science:
- Thoracic surgery
- Congenital chest wall deformities
- Minimally invasive surgery
Background:
- Pectus excavatum encompasses various morphologies, with the extreme eccentric canal type (Grand Canyon type) presenting unique repair challenges due to its significant depression and asymmetry.
- This specific type, characterized by an eccentric longitudinal canal, requires tailored surgical approaches beyond standard pectus excavatum repair techniques.
Purpose of the Study:
- To delineate the morphologic characteristics of extreme eccentric canal type pectus excavatum.
- To evaluate the efficacy of different surgical repair techniques based on the specific morphology.
- To assess repair outcomes using objective pectus indices.
Main Methods:
- A retrospective review of 851 pectus excavatum repairs (1999-2007) identified 112 patients (13.2%) with the extreme eccentric canal type.
- Morphologic characteristics and applied repair techniques (asymmetric bar, seagull bar, crest compression, parallel bar) were analyzed.
- Surgical outcomes were quantified using depression index (DI), asymmetry index (AI), and eccentricity index (EI).
Main Results:
- The eccentric canal type constituted 31% of asymmetric pectus excavatum cases, with a higher female prevalence (M:F ratio 2.3) and a predilection for young adult females.
- Surgical techniques included asymmetric bar (86.6%), parallel bar (70.5%), seagull bar (47.3%), and crest compression (11.6%).
- Significant improvements were observed in DI (2.89 to 1), AI (1.11 to 1.03), and EI (1.69 to 1), indicating successful correction of depression, asymmetry, and eccentricity.
Conclusions:
- Extreme eccentric canal type pectus excavatum is a distinct entity necessitating specialized surgical techniques for optimal correction.
- The asymmetric bar technique effectively addresses post-operative symmetry.
- Parallel bar and seagull bar/crest compression techniques are valuable for correcting upper chest depression and protruding ridges, respectively.
