Eric W Fonkalsrud1. 1. Pediatric Surgery, Department of Surgery, UCLA Medical Center, Los Angeles, California, USA. efonkalsrud@mednet.ucla.edu
Abstract
BACKGROUND: Patients with pectus carinatum (PC) frequently experience physiologic symptoms, which are often overlooked by physicians. Sparse data have been published regarding the indications for correction of PC and the newer techniques of surgical repair. METHODS: Since 1970, 260 (89% males) symptomatic patients with PC with a mean severity index of 1.81 underwent open surgical correction at the University of California, Los Angeles, Medical Center by 1 surgeon. All patients had experienced dyspnea, reduced endurance, and tachypnea with exertion. Asthmatic symptoms were noted by 22%. The mean age at operation was 18.2 years. Asymmetric protrusion was present in 126 (48%) patients. Combined protrusion of the upper chest and depression of the lower chest was present in 17 patients. Varying degrees of depression on one or both sides of the lower chest was present in 36%. Repair of recurrent PC deformities was performed on 16 patients. Progressively, less costal cartilage was resected over the 37-year period, with the last 181 patients having only short segments excised from both ends of deformed cartilages with suture reattachment. Transverse sternal osteotomy was used on all, and 242 (93%) had a support strut anterior to the sternum for 6 months. RESULTS: Exercise induced dyspnea, and reduced endurance was improved in all patients within 3 to 6 months after repair. Need for repair of recurrent deformities and resection of mild residual cartilage protrusion was reduced more than 3-fold when less extensive cartilage resection with wire reattachment was used. Postoperative complications in the last 181 patients were minor and less frequent, pain was less severe, hospitalization was shorter (mean, 2.6 days), and postoperative results were better than when more extensive repairs were used in previous years. With a mean overall follow-up of 6.2 years, 97.4% of all patients reported a very good or excellent result. CONCLUSIONS: In this largest reported series of PC repair, progressively less extensive open techniques have resulted in low morbidity, mild pain, short hospital stay, and very good physiologic and cosmetic results.
BACKGROUND:Patients with pectus carinatum (PC) frequently experience physiologic symptoms, which are often overlooked by physicians. Sparse data have been published regarding the indications for correction of PC and the newer techniques of surgical repair. METHODS: Since 1970, 260 (89% males) symptomatic patients with PC with a mean severity index of 1.81 underwent open surgical correction at the University of California, Los Angeles, Medical Center by 1 surgeon. All patients had experienced dyspnea, reduced endurance, and tachypnea with exertion. Asthmatic symptoms were noted by 22%. The mean age at operation was 18.2 years. Asymmetric protrusion was present in 126 (48%) patients. Combined protrusion of the upper chest and depression of the lower chest was present in 17 patients. Varying degrees of depression on one or both sides of the lower chest was present in 36%. Repair of recurrent PC deformities was performed on 16 patients. Progressively, less costal cartilage was resected over the 37-year period, with the last 181 patients having only short segments excised from both ends of deformed cartilages with suture reattachment. Transverse sternal osteotomy was used on all, and 242 (93%) had a support strut anterior to the sternum for 6 months. RESULTS: Exercise induced dyspnea, and reduced endurance was improved in all patients within 3 to 6 months after repair. Need for repair of recurrent deformities and resection of mild residual cartilage protrusion was reduced more than 3-fold when less extensive cartilage resection with wire reattachment was used. Postoperative complications in the last 181 patients were minor and less frequent, pain was less severe, hospitalization was shorter (mean, 2.6 days), and postoperative results were better than when more extensive repairs were used in previous years. With a mean overall follow-up of 6.2 years, 97.4% of all patients reported a very good or excellent result. CONCLUSIONS: In this largest reported series of PC repair, progressively less extensive open techniques have resulted in low morbidity, mild pain, short hospital stay, and very good physiologic and cosmetic results.