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Ann Thorac Surg 2007;83:1849
© 2007 The Society of Thoracic Surgeons
Department of Thoracic Surgery, Royal Brompton Hospital, Sydney St, London, SW3 6NP United Kingdom
(Email: p.goldstraw{at}rbh.nthames.nhs.uk).
Since its introduction by Dr Donald Nuss, minimally invasive repair of pectus excavatum (MIRPE) has become the procedure of choice when dealing with this condition in young patients. Now many surgeons also consider it to be an excellent option when undertaking such surgery in adults. The Ravitch-type corrections remain necessary when dealing with complex, asymmetrical deformities of the carinatum and arcuatum type. However, for those patients in whom the deformity is suitable for MIRPE, there are several advantages to this approach. The surgical incisions have less impact on the cosmetic result, there is less tissue damage, less blood loss, and possibly a shorter hospital stay. However, the primary indication for all such surgery is cosmetic; therefore, it is important to assess the results of any new operation from the patient’s perspective.
Lawson and colleagues [1] reported the outcome in terms of cosmesis and symptom improvement in Dr Nuss’s pediatric patients using a two-step questionnaire that was completed by the parent and the patient, if old enough. They demonstrated an improvement in nearly all of the quality-of-life domains assessed at 6 to 12 months after surgical correction, prior to the removal of the pectus bar.
In our study [2] we reported the development of a single-step questionnaire and validated its use in young adult males. We showed a significant improvement in domains related to self-esteem, social function, and cosmetic appearance at a mean interval of 5 months after correction, before removal of the pectus bar.
In the current issue, Metzelder and colleagues [3] report their experience with MIRPE using the same single-step questionnaire to assess patient satisfaction with the results of surgery. Although we have reservations as to the objectivity of the assessment at 6 months after correction, the analysis of the single-step questionnaire, completed at a variable time of up to 4 years after removal of the bar, shows levels of satisfaction in all domains at least as good as those reported by us. This suggests that patient satisfaction is maintained after removal of the bar, at least in the short to medium term. In addition, perhaps this suggests that patient satisfaction increases as time goes by, possibly associated with removal of the pectus bar.
This publication adds to the growing evidence that MIRPE provides a durable cosmetic improvement in suitable cases of pectus excavatum, with high levels of patient satisfaction reported at a mean follow-up of 54 months after correction, 23 months after bar removal.
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