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Original Articles: General Thoracic

Routine Use of Minimally Invasive Surgery for Pectus Excavatum in Adults

^a Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby Aarhus, Denmark
^b Department of Cardiothoracic Surgery, Odense University Hospital Odense, Denmark

Accepted for publication April 23, 2008.

^_* Address correspondence to Dr Pilegaard, Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus, 8200, Denmark (Email: pilegaard{at}dadlnet.dk).

Presented at the Poster Session of the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: The Nuss operation, a minimally invasive repair of pectus excavatum, is considered the treatment of choice in children. It is controversial in adults, but smaller series have been published. We have used the Nuss operation routinely in adults since 2003.

Methods: The indication for operation was a patient-described disabling cosmetic appearance. We modified the operation by using a shorter pectus bar, which appears to be more stable. All patient records were available and analyzed retrospectively.

Results: Operations for pectus excavatum were done in 475 patients (89% men) at Aarhus University Hospital. 180 patients (38%) were aged 18 years or older, median patient age was 22 years (range, 18 to 43 years). All but one patient achieved an excellent cosmetic result. Two pectus bars were required in 57 patients (32%), and 2 patients required 3 pectus bars. The median duration of the procedure was 41 minutes (range, 16 to 119 minutes), which was significantly longer compared with younger patients, but the difference was not clinically relevant (6 minutes). Pneumothorax occurred in 86 patients (48%), but only 4 (2%) required chest tube drainage. In 3 patients the pectus bar dislocated during follow-up.

Conclusions: Minimally invasive repair for pectus excavatum can be performed safely in adults, with excellent immediate cosmetic results. Adults often require more than 1 pectus bar. From the results of this large series, we conclude that patients aged younger than 50 years are eligible for minimally invasive surgical correction of pectus excavatum.

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Invited Commentary

Dawn Jaroszewski
Ann. Thorac. Surg. 2008 86: 957. [Extract] [Full Text] [PDF]

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				H. K. Pilegaard and P. B. Licht Can absorbable stabilizers be used routinely in the Nuss procedure? Eur. J. Cardiothorac. Surg., April 1, 2009; 35(4): 561 - 564. [Abstract] [Full Text] [PDF]

				D. Jaroszewski Invited Commentary Ann. Thorac. Surg., September 1, 2008; 86(3): 957 - 957. [Full Text] [PDF]