Minimally invasive repair for pectus excavatum in adults
Swee H Teh1, Angela M Hanna, Tuan H Pham
1Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Background:
The purpose of this study is to review the minimally invasive pectus excavatum repair in adults to determine the safety and effectiveness.
Methods:
An Institutional Review Board approved chart review identified patients 17 years or older who underwent minimally invasive pectus excavatum repair (MIPER) between January 1999 and January 2004.
Results:
Nineteen patients underwent MIPER. Indications for surgery were reduced exercise tolerance (13), dyspnea on exertion (17), improve self-perception (10), and chest pain (6). There were no intraoperative complications or conversions to open repair. Twelve patients (63%) required one strut and seven patients (37%) required two struts. Postoperative complications included self-resolving asymptomatic pneumothorax in six patients and pneumonia in one. Pain at six weeks postoperatively was mild to none in most patients and all had no pain at three months postoperatively except one patient with strut displacement. Two patients required removal of one of two struts due to displacement. The mean postoperative pectus index was significantly lower than preoperative value: 2.5 versus 4.6, p = 0.002. Among six patients with strut removal at two years postoperatively, two patients had mild recurrence of their deformity.
Conclusions:
Minimally invasive pectus excavatum repair can be performed safely in adults. This approach is technically more challenging in adults with one-third of the patients requiring two struts for optimal repair. The risk of strut displacement is higher than in the pediatric population. The long-term effectiveness and durability of this procedure in adults is still unknown.
Insights
Minimally invasive pectus excavatum repair (MIPER) is safe for adults, though technically challenging. While effective in improving pectus index, long-term outcomes and strut durability require further study.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Procedures
- Adult Chest Wall Deformities
Background:
- Pectus excavatum is a chest wall deformity.
- Surgical repair aims to correct the deformity and alleviate symptoms.
- Minimally invasive techniques offer potential advantages over traditional open repairs.
Purpose of the Study:
- To review the safety and effectiveness of minimally invasive pectus excavatum repair (MIPER) in adult patients.
- To evaluate surgical outcomes and complications associated with MIPER in this population.
Main Methods:
- Retrospective chart review of adult patients (≥17 years) who underwent MIPER.
- Data collected on patient demographics, surgical indications, operative details, and postoperative outcomes.
- Analysis of complications, pain levels, pectus index changes, and long-term recurrence.
Main Results:
- Nineteen adult patients underwent MIPER for reduced exercise tolerance, dyspnea, self-perception, and chest pain.
- No intraoperative complications or conversions to open repair occurred.
- The mean postoperative pectus index significantly improved (2.5 vs. 4.6, p=0.002).
- Postoperative complications included pneumothorax and pneumonia; two patients required strut removal due to displacement.
- Mild recurrence was observed in two of six patients undergoing strut removal at two years.
Conclusions:
- Minimally invasive pectus excavatum repair is a safe procedure for adults.
- Adult MIPER is technically more demanding, with a higher risk of strut displacement compared to pediatric cases.
- Long-term effectiveness and durability of MIPER in adults remain to be determined.
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