Which patients are best suited for minimally invasive repair of pectus excavatum?

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

The current recommendations support the use of MIRPE in patients aged 5-20 years. The ideal age for undergoing this operation is 8-12 years because the chest wall is still very malleable, stabilization of the bar is easily achieved, thoracic epidural can be safely placed, and the child is mature enough to understand the operation and postoperative instructions, particularly incentive spirometry, which is essential for minimizing pulmonary problems after surgery.

Of note, one should not view operative correction of pectus excavatum as an operation limited exclusively to pediatric patients. Indeed, the open technique has been used in adult patients with excellent results. However, experience with the MIRPE in adult patients has been limited to a few cases, reported in anecdotes. Early results seem to indicate that similar principles apply and that operative correction using MIRPE can be achieved in adult patients. Limiting factors include a larger chest wall and poor malleability of the ribs, cartilage, and sternum. A surgeon experienced in the field of chest wall malformations must carefully evaluate adult patients to determine which operation would best correct the anatomical deformity.

An interesting observation has been that complications, mainly bar displacement, have appeared to be more common in teenaged patients. Initially, the MIRPE was limited to the younger prepubertal patients (aged 3-12 y), which probably accounted for the rare occurrence of bar displacement in the first report by Nuss. [10] Older patients were offered the procedure because of the success of the procedure in young patients. Only later was the importance of proper stabilization of the bar identified and the lateral stabilizing bar was introduced (in 1998), followed by the addition of the third point of fixation technique (in 2000) to provide additional support and stability for the bar. The results seemed to have improved so much that the operation is now considered even in older adult patients with pectus excavatum.


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