Minor and Major Complications Related to Minimally Invasive Repair of Pectus Excavatum

The technique for minimally invasive repair of pectus excavatum (MIRPE) has been adopted by most surgeons as the preferred method for treatment of this condition. However, there is limited awareness about the complications related to the procedure. Most importantly, the prevalence and potential for life-threatening complications have frequently been underestimated. The purpose of this communication is to increase awareness of the risk of minor and major (life-threatening) complications, as well as the operative steps and modifications which have been developed to prevent them. One of the most common complications reported in the early series of MIRPE cases was bar displacement, frequently requiring reoperation. Fortunately, technical modifications to the technique have resulted in a decrease in the incidence of such events from 10 to less than 2%. It is important for surgeons to have a good understanding of the potential complications, particularly the major type of complications post-MIRPE and postpectus bar removal. Although rare, the risk of mortality is real and it is the surgeon's responsibility to ensure optimal patient safety when performing this procedure. Factors such as operative technique, patient age, pectus severity and asymmetry, previous chest surgery, and the surgeon's experience play a role in the overall incidence of adverse events. These preventable events can be avoided with proper training, mentoring, and careful patient selection.