Minimally invasive repair of pectus excavatum deformity
George Krasopoulos1, Peter Goldstraw
1St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK. gk1@europe.com, gkraso@iname.com
Abstract:
This review is trying to address the effectiveness and sustainability of results following minimally invasive repair of pectus excavatum (MIRPE). The aim is to present these results for the benefit of clinicians and the patients. Literature search has revealed 179 hits, which were independently assessed and led to 80 publications being formally reviewed. Studies reporting results from less than 10 patients were excluded. Thirty-five studies were found to be reporting results from patients' and/or surgeons' perspective and they were included in this review. Data from the United Kingdom registry for MIRPE were also included. Results from over 2997 patients (age: <1-85 years) who had MIRPE and 1393 patients who had their metallic bar removed were assessed. The most common indication for surgery was cosmesis. There was a net gain with regard to self-esteem for 96-100% of the individuals. A percentage of procedures (0-20%) was assessed by surgeons as having an 'unsatisfactory outcome' and a number of patients (0-25%) reported an 'unsatisfactory end result.' However, these percentages are not necessarily referring to the same patients and an unsatisfactory result does not seem to affect the positive effect on self-esteem. The reported changes in social life, lung capacity, cardiovascular capacity, exercise capacity and general health are based on weak data and significant improvements, if any, are probably seen in a limited number of patients. The metallic bars were removed after 1.5-4.5 years and there is an overall 0-4.5% reported recurrence post-bar removal. In conclusion, MIRPE may improve cosmesis and self-esteem of patients with pectus excavatum deformity. Direct or indirect improvement in other physiological parameters may also help the 'well-being' of these patients and their social integration. There is a clear need for standardisation in the way results are reported in the literature and a socioeconomic analysis with regard to gains, benefits and costs related to MIRPE.
Insights
Minimally invasive repair of pectus excavatum (MIRPE) significantly improves patient self-esteem and cosmetic appearance. While some unsatisfactory outcomes occur, they rarely impact self-esteem, and recurrence rates post-bar removal are low.
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Plastic surgery
Background:
- Pectus excavatum is a congenital chest wall deformity affecting physical appearance and potentially physiological function.
- Minimally invasive repair of pectus excavatum (MIRPE) has emerged as a common surgical approach.
- Assessing the long-term effectiveness and patient-reported outcomes of MIRPE is crucial for clinical guidance.
Purpose of the Study:
- To review and synthesize the existing literature on the effectiveness and sustainability of results following MIRPE.
- To provide a comprehensive overview of outcomes from both patient and surgeon perspectives.
- To identify areas for improvement in reporting and future research.
Main Methods:
- A systematic literature search identified 179 studies, with 35 selected for review based on predefined criteria (minimum 10 patients).
- Data from the United Kingdom registry for MIRPE were incorporated.
- Outcomes from over 2997 patients undergoing MIRPE and 1393 patients with bar removal were analyzed.
Main Results:
- Cosmesis was the primary indication for surgery, with 96-100% of patients reporting improved self-esteem.
- Surgeons reported unsatisfactory outcomes in 0-20% of cases, and patients in 0-25%, with no clear correlation to self-esteem impact.
- Low recurrence rates (0-4.5%) were observed post-bar removal (1.5-4.5 years).
- Evidence for significant improvements in lung capacity, cardiovascular function, and exercise capacity was generally weak.
Conclusions:
- MIRPE is effective in improving the cosmetic appearance and self-esteem of patients with pectus excavatum.
- While physiological improvements are less consistently documented, MIRPE can contribute to overall well-being and social integration.
- Standardization of outcome reporting and socioeconomic analyses are needed for MIRPE.
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