How early can we repair pectus excavatum: the earlier the better?
Hyung Joo Park1, Sook-Whan Sung, Jae-Kil Park
1Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Korea. hyjpark@catholic.ac.kr
Insights
Early repair of pectus excavatum (PE) in children over 3 years old using minimally invasive surgery is safe and effective. This approach reduces asymmetry and enhances patient growth potential, leading to better chest wall conformation.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Pectus excavatum (PE) is a congenital chest wall deformity.
- The optimal age for minimally invasive PE repair remains debated.
- Early repair may preserve chest wall integrity and promote growth.
Purpose of the Study:
- To evaluate the advantages of early minimally invasive pectus excavatum repair.
- To determine the impact of age on repair outcomes.
- To assess complication rates, growth, asymmetry, and chest wall conformation.
Main Methods:
- Retrospective analysis of 1571 patients undergoing minimally invasive PE repair (1999-2011).
- Patients categorized into four age groups: ≤5, 6-11, 12-20, and >20 years.
- Comparative analysis of complication rates, growth percentiles (height, weight, BMI), asymmetry, and costal flare scores.
Main Results:
- Lowest asymmetry incidence and complication rates observed in the youngest group (≤5 years).
- Significant improvement in body weight growth noted in patients ≤11 years.
- Costal flare score decreased significantly in patients ≤11 years; no improvement in older groups.
Conclusions:
- Routine early repair of pectus excavatum (in patients >3 years) is safe and effective.
- Early intervention minimizes asymmetry and enhances growth potential.
- Recommends early repair for optimal chest wall normalization and improved patient outcomes.
Objectives:
The optimal age for the repair of pectus excavatum using minimally invasive technique has yet to be determined. We hypothesized that the early repair of pectus excavatum may contribute in preserving chest wall integrity and also in enhancing patients' growth. The purpose of our present study was to verify a potential advantage of the early repair of pectus excavatum by using a minimally invasive technique.
Methods:
For our study on minimally invasive pectus excavatum repair, 1571 patients from the period 1999 to 2011 were enrolled. Our strategy was to carry out routine repairs in patients older than 3 years of age. To examine the age factor on the results of the repairs the patients were divided into different age groups: Group 1 (≤ 5 years, 618 (39.3%)), Group 2 (6-11 years, 322 (20.5%)), Group 3 (12-20 years, 401 (25.5%)) and Group 4 (>20 years, 230 (14.6%)). A comparative analysis was performed for factors such as complication rates; growth-percentile scores of height, weight and body mass index (BMI); incidence of asymmetry and costal flare score to determine the potential to resume the normal chest wall conformation by earlier repair.
Results:
The mean age of the patients was 10.2 years (16 months to 51 years). The incidence of asymmetry was found to be lowest in Group 1 (24.3, 45.5, 58.7, 48.4%, respectively, P < 0.001). The complication rate after repair was also lowest in Group 1 (7.6, 11.5, 16.3, 19.1%, respectively, P < 0.001). The growth of body weight was significant in Groups 1 and 2 (0.53 ± 1.02, P < 0.001). The costal flare score was found to have decreased in Groups 1 and 2 (Group 1: from 1.6 to 0.12, P < 0.001; Group 2: from 1.44 to 0.14, P < 0.001). In Groups 3 and 4, there was no improvement in costal flare after repair.
Conclusions:
Our results suggest that routine early repair of pectus excavatum in patients older than 3 years of age is safe and effective. We would recommend early repair to avoid asymmetry transformation of the deformity and to enhance the patients' growth potential.
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