Contemporary management of recurrent pectus excavatum
Maria Grazia Sacco Casamassima1, Dominic Papandria1, Seth D Goldstein1
1Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Journal of Pediatric Surgery
|May 13, 2015
Summary
The Nuss procedure is effective for recurrent pectus excavatum (PE) repair, regardless of prior surgery. Open repair is still valuable for severe PE cases with sternocostal abnormalities.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Surgery
Background:
- Optimal management for recurrent pectus excavatum (PE) remains undefined.
- This study reviews institutional experience with recurrent PE to assess outcomes and propose a classification and algorithm.
Purpose of the Study:
- Evaluate long-term outcomes of recurrent PE management.
- Develop an anatomic classification and decision-making algorithm for recurrent PE.
Main Methods:
- Retrospective review of 85 patients with recurrent PE (1996-2011).
- Analysis of initial and revision surgical techniques (Ravitch, Nuss, open repair).
- Logistic regression to identify predictors of re-recurrence.
Main Results:
- Nuss repair was the most frequent revision (86%).
- Satisfactory cosmetic and functional results were achieved in 91.8% of Nuss repairs versus 58% of other techniques.
- No significant predictors for re-recurrence were identified.
Conclusions:
- The Nuss procedure is an effective treatment for recurrent PE, irrespective of the initial repair method.
- Open repair remains a viable option for severe cases with sternocostal junction abnormalities and cartilage regrowth.
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