What are the advantages and disadvantages of minimally invasive repair of pectus excavatum (MIRPE)?

Updated: Oct 30, 2018
  • Author: Andre Hebra, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Answer

Critics of the MIRPE claim that the Nuss procedure is too invasive, too risky, and not pain free. Proponents argue that this new approach, compared with the open surgery (modified Ravitch operation), eliminates the need for a large anterior chest wall incision with creation of pectoralis muscle flaps, resection of several ribs and cartilages, and sternal osteotomies. The MIRPE allows for a much shorter operating time, minimal blood loss, and minimal anterior chest wall scar. [15]  Moreover, the stability and strength of the chest wall is not compromised as it is with the open repair. For a more detailed review of the pros and cons of both approaches, please refer to the article "To Nuss or Not to Nuss? Two Opposing Views" in the Spring 2009 edition of Seminars of Thoracic and Cardiovascular Surgery. [16]

Another significant advantage of MIRPE over the open surgical procedure is that the dreaded complication of "thoracic constriction" (Jeune syndrome) does not seem to occur with this new technique. Chest wall constriction has been described in a few patients following extensive open pectus excavatum operations. Apparently, the bone growth center can be affected, which results in restriction of chest wall growth with marked limitation of ventilatory function. Such patients are very symptomatic and cannot compete in running games. The forced vital capacity and forced expiratory volume in one second is typically decreased by more than 50% of predicted reference range levels. With the MIRPE, because no resection or incision is made on ribs or cartilages, such a complication does not appear to be a problem. Once the cartilage and bony structures are remodeled, normal or improved pulmonary function is established and the flexibility and malleability of the chest remains unaffected.


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