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Surgical repair of pectus excavatum
1Department of Surgery, Children's Hospital, Boston, MA 02115.
Insights
This study reports on 704 pectus excavatum corrections, finding the condition more common in boys and often present from birth. Surgical repair yielded satisfactory long-term results with a low complication rate.
Area of Science:
- Thoracic Surgery
- Pediatric Surgery
- Congenital Deformities
Background:
- Pectus excavatum is a common congenital chest wall deformity.
- The condition is more prevalent in males and often evident within the first year of life.
- Associated musculoskeletal and cardiac abnormalities can occur.
Purpose of the Study:
- To review surgical outcomes for pectus excavatum over a 29-year period.
- To analyze complication rates and long-term results of a specific surgical technique.
Main Methods:
- A retrospective review of 704 pectus excavatum patients treated between 1958 and 1987.
- Surgical technique involved bilateral subperichondrial resection of costal cartilages and sternal osteotomy.
- Fixation methods included silk sutures and, in early cases, Steinman pins.
Main Results:
- 704 patients underwent surgical correction, with 86% having defects present from birth.
- A low overall complication rate of 4.4% was observed.
- Major recurrence occurred in 2.7% of patients, requiring revision in 12 cases.
Conclusions:
- The described surgical technique for pectus excavatum repair is effective.
- Satisfactory long-term results were achieved in the majority of patients.
- Careful patient selection and surgical technique are crucial for optimal outcomes.
Abstract:
From 1958 to March 1987 we corrected 704 patients with pectus excavatum. The condition occurred more frequently in boys (544 patients) than girls (160 patients). In the majority of patients (86%), the defect was evident at birth or within the first year of life. Musculoskeletal abnormalities were identified in 133 patients (scoliosis, 107; kyphosis, 4; myopathy, 3; Poland's syndrome, 3; Marfan's syndrome, 2; Pierre Robin syndrome, 2; prune belly syndrome, 2; neurofibromatosis, 3; cerebral palsy, 4; tuberous sclerosis, 1; and congenital diaphragmatic hernia, 2). Sixteen patients had associated congenital heart disease. A family history of chest wall deformity was present in 37% of the cases and a history of scoliosis in 11%. Surgical correction was performed using a uniform technique for bilateral subperichondrial resection of the deformed costal cartilages and sternal osteotomy resecting a wedge of the anterior cortex and fracturing the posterior cortex. Anterior displacement was maintained with silk sutures closing the osteotomy defect. In 28 early cases, the sternum was secured by intramedullary fixation with a Steinman pin. All repairs were completed with a low complication rate (4.4%; pneumothorax, 11; wound infection, 5; wound hematoma, 3; wound dehiscence, 5; pneumonia, 3; seroma, 1; hemoptysis, 1; hemopericardium, 1). Six complications were associated with Steinman pin fixation (hemoptysis, seroma, hemopericardium, pneumothorax, 3). Major recurrence occurred in 17 patients (2.7%) and led to revision in 12. Satisfactory long-term results were achieved in the remaining 687 patients, with follow-up ranging from 2 weeks to 27 years. Mean follow-up was 4.3 years.(ABSTRACT TRUNCATED AT 250 WORDS)