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Thoracic Surgical Correction of Pectus Excavatum: Minimal and Open Approaches

  • Ian HuntEmail author
  • Stephanie Fraser
Chapter

Abstract

Pectus excavatum is the most common congenital chest wall deformity affecting 1 in 300–400 births. Patients typically describe a combination of physical and psychological symptoms relating to their deformity which can be debilitating for this young patient population. Surgical correction of the underlying chest wall deformity through internal bracing (MIRPE, minimally invasive repair of pectus excavatum or the Nuss procedure) or through a ‘break and re-set’ of the chest wall (modified Ravitch procedure) remains an important option in treating pectus excavatum particularly in the context of functional impairment.

References

  1. 1.
    Kragten HA, Siebenga J, Höppener PF, Verburg R, Visker N. Symptomatic pectus excavatum in seniors (SPES): a cardiovascular problem?: a prospective cardiological study of 42 seniors with a symptomatic pectus excavatum. Neth Heart J. 2011;19:73–8.CrossRefGoogle Scholar
  2. 2.
    Luo L, Xu B, Wang X, Tan B, Zhao J. Intervention of the Nuss procedure on the mental health of pectus excavatum patients. Ann Thorac Cardiovasc Surg. 2017;23(4):175–80.  https://doi.org/10.5761/atcs.oa.17-00014.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Poston PM, Patel SS, Rajput M, Rossi NO, Ghanamah MS, Davis JE, Turek JW. The correction index: setting the standard for recommending operative repair of pectus excavatum. Ann Thorac Surg. 2014;97(4):1176–9; discussion 1179–80.CrossRefGoogle Scholar
  4. 4.
    Lawson ML, Mellins RB, Paulson JF, Shamberger RC, Oldham K, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb GW III, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Moskowitz AB, Hill J, Kelly RE Jr. Increasing severity of pectus excavatum is associated with reduced pulmonary function. J Pediatr. 2011;159(2):256–61.e2.CrossRefGoogle Scholar
  5. 5.
    Kelly RE Jr, Obermeyer RJ, Nuss D. Diminished pulmonary function in pectus excavatum: from denying the problem to finding the mechanism. Ann Cardiothorac Surg. 2016;5(5):466–75.CrossRefGoogle Scholar
  6. 6.
    Jayaramakrishnan K, Wotton R, Bradley A, Naidu B. Does repair of pectus excavatum improve cardiopulmonary function? Interact Cardiovasc Thorac Surg. 2013;16(6):865–70.CrossRefGoogle Scholar
  7. 7.
    Maagaard M, Heiberg J. Improved cardiac function and exercise capacity following correction of pectus excavatum: a review of current literature. Ann Cardiothorac Surg. 2016;5(5):485–92.CrossRefGoogle Scholar
  8. 8.
    Kanagaratnam A, Phan S, Tchantchaleishvilli V, Phan K. Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis. Ann Cardiothoracic Surg. 2016;5(5):409–21.CrossRefGoogle Scholar
  9. 9.
    Ravitch MM. Technical problems in the operative correction of pectus excavatum. Ann Surg. 1965;162:29–33.CrossRefGoogle Scholar
  10. 10.
    Fonkalsrud EW. Open repair of pectus excavatum with minimal cartilage resection. Ann Surg. 2004;240(2):231–5.CrossRefGoogle Scholar
  11. 11.
    Robicsek F. Marlex mesh support for the correction of very severe and recurrent pectus excavatum. Ann Thorac Surg. 1978;26(1):80–3.CrossRefGoogle Scholar
  12. 12.
    Nuss D, Kelly JE. The minimally invasive repair of pectus excavatum. Oper Tech Thorac Cardiovasc Surg. 2014;19(3):324–47.CrossRefGoogle Scholar
  13. 13.
    Pilegaard HK. Single centre experience on short bar technique for pectus excavatum. Ann Cardiothorac Surg. 2016;5(5):450–5.CrossRefGoogle Scholar
  14. 14.
    Park HJ. A technique for complex pectus excavatum repair: the cross-bar technique for Grand Canyon type deformity (Park classification). Ann Cardiothorac Surg. 2016;5(5):526–7.CrossRefGoogle Scholar
  15. 15.
    Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg. 2005;40(3):496–500.CrossRefGoogle Scholar
  16. 16.
    Park HJ, Kim KS. The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex. Ann Cardiothorac Surg. 2016;5(5):434–9.CrossRefGoogle Scholar
  17. 17.
    Frawley G, Frawley J, Crameri J. A review of anesthetic techniques and outcomes following minimally invasive repair of pectus excavatum (Nuss procedure). Paediatr Anaesth. 2016;26(11):1082–90.CrossRefGoogle Scholar
  18. 18.
    Hebra A, Kelly RE, Ferro MM, Yüksel M, Campos JRM, Nuss D. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg. 2018;53(4):728–32. pii: S0022–3468(17)30461-X.CrossRefGoogle Scholar
  19. 19.
    Park HJ, Kim KS. Pectus bar removal: surgical technique and strategy to avoid complications. J Vis Surg. 2016;2:60.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Pectus ClinicLondonUK
  2. 2.Guy’s HospitalLondonUK

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