Minimally invasive surgery (MIS) for repair of Pectus Excavatum (PE) has been widely used for pediatric patients. However, its application in adult patients has been limited. We reviewed the outcomes of 30 patients treated with MIS.
Data was compiled from a survey of pediatric surgeons and combined with the main author’s experience in treating adult patients with PE. Thirty subjects (age range: 18 - 32 years of age, mean: 23 years; 75% males) with PE were treated with the MIS. The main indication for surgery was cosmetic (80%). Retrospective analysis of outcomes was conducted on the patients operated by the main authors and combined with survey results.
In 60% of cases the operative time was between one and two hours. Thoracic epidural was successfully utilized for postoperative pain management in 90% of patients. Two Lorenz pectus bars were necessary in 16% and bilateral stabilizers were used in 53% of patients. Complications included: Seroma (10%), bar displacement (6%), pneumothorax requiring tube thoracostomy (6%), superficial wound infection (3%), and stabilizer bar fracture (3%). Two patients required conversion to modified Ravitch repair. Patient satisfaction was rated as Excellent (50%), Good (36%), and Fair (14%). Less than 50% of patients achieved 100% correction of their deformity.
The MIS can be used safely for repair of PE in adult patients. The complication rate appears to be similar to previously reported series of pediatric patients. Two bars may be necessary for optimal results in selected cases. Postoperative pain appears to be more pronounced and prolonged compared to younger patients. This preliminary report suggests that adults are less likely to achieve complete correction of the pectus deformity and many have residual asymmetry of the chest. The overall results do not appear to be as good as reported for younger patients.
The repair of pectus excavatum in adult patients can be sucessfully accomplished using the minimally invasive technique originaly described for pediatric patients.
A. Hebra, None.