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Minimally Invasive Repair of Pectus Excavatum: 10-Year Appraisal with 1,170 Patients
Hyung Joo Park, Jongho Cho, Kwang Taik Kim, Young Ho Choi; Korea University Medical Center, Seoul, Korea, South
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Objective: The minimally invasive repair of pectus excavatum (MIRPE) was introduced by Nuss in 1998. Since then, serious problems associated with lack of experience and insufficient surgical techniques have hindered this procedure to progress. We started this new procedure in 1999, and to overcome these obstacles, the concepts of the repair as well as surgical techniques have been modified continuously. As a result, the morphology-tailored approach with a diverse bar-shaping, bar fixation techniques, and techniques for adults were developed. To reset the most current status of the MIRPE, our 10-year experience was appraised.
Methods: A single surgeon (HJP) experience with 1,170 consecutive pectus excavatum patients between August 1999 and September 2008 was analyzed. All patients treated with the author’s modifications were enrolled to assess the efficacy of repair techniques and surgical outcomes.
Results: The mean age of the patients were 10.3 years (range: 16 months to 51 years). Male to female ratio was 4.1. Adult patients (age=/>15 years) were 331(28.3%). 491 patients (42.0%) had bar removal mean of 2.5 years (range: 3months to 7years) after the bar placement. To repair the eccentric and unbalanced asymmetry, the asymmetric bar (n=471, 40.3%), the seagull bar (n=219, 18.7%), and the crest compression technique (n=119, 10.2%) were employed. Post-repair symmetry of the asymmetric types was verified with the asymmetry index (AI) (Pre: 1.10 vs. Post: 1.02, p<0.001). Techniques for the adults were the compound bar (n=244, 20.9%) and the crane technique (n=397, 33.9%). Changes of complication rates between 1999 and 2008 were: total complication (15/51, 29.4% vs. 9/185, 4.9%, p<0.001), pneumothorax (10/51, 19.6% vs. 1/185, 0.5%, p<0.001), and bar displacement rate (4/51, 7.8% vs. 0/185, 0%, p=0.037). Reoperation rate also decreased (7/51, 13.7% vs. 1/185, 0.5%, p<0.001). (Figure1). Satisfaction outcomes were excellent in 1,085/1170(92.7%), good in 69/1,170(5.9%), and fair in 16/1,170(1.4%). After the bar removal, 3 patients (0.6%) had minor recurrence, and two of them were undergone reoperation.
Conclusion: The morphology-tailored approach and the techniques devised for adults seem to be effective in repair of complex pectus excavatum, including asymmetry and older patients. With the authors’ techniques refined during the past 10 years, this new minimally invasive procedure can be safely applied to a full spectrum of pectus excavatum with low morbidity and favorable outcomes.


Figure 1. Changes of Complication and Reoperation rates. Analysis of 1,170 patients from 1999 through 2008 revealed that the Multipoint Bar Fixation technique (MPF) at Period 1 (P1), and routine Hemo-vac drainage (HVD) at Period 2 (P2) are attributed to major reductions of complications.
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