Minimally invasive repair after inefficient open surgery for pectus excavatum

Pectus excavatum is the most common chest wall deformity, and both open surgery and minimally invasive repair have been proposed for primary correction. The aim of this study was to show the feasibility of minimally invasive repair of recurrent pectus excavatum in patients with inefficient previous open surgery.

A total of 135 patients underwent minimally invasive repair of pectus excavatum between June 2006 and February 2010. Ten patients had a previous unsatisfactory open surgical repair of the deformity. Operation duration, length of hospital stay, complications and the need for a revision operation were compared between the primary Nuss (N) and the Nuss after Ravitch (RN) groups.

The N group consisted of 125 patients, requiring 133 operations, whereas 10 patients in the RN group underwent 11 minimally invasive correction operations. For the N and RN groups, medians of operation duration and length of hospital stay were 60 (20-180) and 60 (30-120) min, and 5 (2-15) and 5 (3-10) days, respectively. The differences between the two values were found to be statistically insignificant (p > 0.05). Development of perioperative or postoperative complications in both groups was found not to be associated with primary or redo minimally invasive surgery (p > 0.05).

Minimally invasive repair is a safe and easy operation for the correction of pectus excavatum. Previous open surgical repair is not a contraindication for the redo minimally invasive surgery, and it can be performed with acceptable morbidity and length of hospital stay.