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Ann Thorac Surg 1997;63:303-304
© 1997 The Society of Thoracic Surgeons

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Correspondence

Operation for Pectus Excavatum

7Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond St, London WC1N 3jh, United Kingdom

To the Editor:

I agree with Haller and colleagues [1] that operation for pectus excavatum is not often indicated before the age of 4 years. In my personal experience, only about 10% of patients have been in that age group. I changed my operative technique in 1979 from the Ravitch to the Wada type of operation. I have never seen the chest wall constriction as described by Haller and colleagues in any of my patients. This may perhaps be another argument in favor of sternal turnover versus the Ravitch operation.

Reference

1. Haller JA Jr, Colombani PM, Humphries CT, Azizkhan RG, Loughlin GM. Chest wall constriction after too extensive and too early operations for pectus excavatum. Ann Thorac Surg 1996;61:1618–25.[Abstract/Free Full Text]

Reply To the Editor:

Division of Pediatric Surgery, Johns Hopkins Children's Center, 600 N Wolfe St, CMSC 7-116 Baltimore, MD 21287-3716

I am pleased that Dr Stark's large experience at Great Ormond Street Hospital supports our feeling that very young children should not have operative repair of pectus excavatum. In spite of Professor Wada's good experience with his sternal turnover operation, I believe that is too extensive for children and sooner or later major infections will occur in what is a very large free bone graft. For teenagers this operation is acceptable if you do not like the Ravitch repair with a substernal bar, but I believe a 2-hour operation in children is better than a 4-hour sternal turnover.

With a less extensive operation in much older children and teenagers, as Dr Stark points out, we should not see the disastrous chest wall constriction that we reported.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Stark, J. Articles by Haller, J. A. Search for Related Content PubMed Articles by Stark, J. Articles by Haller, J. A., Jr