Minimally invasive repair of pectus excavatum in children: insights from a large cohort at a single institution.

BACKGROUND

The outcomes and potential for recurrence following surgical correction of pectus excavatum (PE) in the pediatric population remain unresolved. We carried out non-delayed PE repair in all patients aged 5 years or older. This study aimed to verify the safety and effectiveness of pediatric PE repair, based on our 10-year research data, focusing on the incidence of recurrence and the advanced strategy of using the crane sternal pre-lifting and multiple pectus bars for anatomical chest wall remodeling.

METHODS

From January 2013 to July 2023, a cohort of 816 pediatric patients aged ≤10 years (range, 3-10 years) underwent PE repair using pectus bars to assess the outcomes of the procedure. Among these, we specifically focused on 173 patients who underwent surgery within the last 3 years (2020-2022), during which our approach shifted to the multiple bar technique for pediatric patients. This subset was divided into the single-bar (Group S, 87 patients) and multiple-bar (Group M, 86 patients) approaches for comparison. The analysis of outcomes included changes in the computed tomography severity index (Haller index), complication rates, length of hospital stay, and reoperation incidence, with a specific focus on recurrence.

RESULTS

The two groups had similar baseline characteristics, and there was no recurrence in either group in the recent 3-year analysis. In the single- and multiple-bar group comparisons, most Group M patients underwent repair with two pectus bars (2 bars: 84, 3 bars: 2, P=0.045). The length of stay showed no significant difference between the groups (Group S; 4.63 days Group M: 4.40 days, P=0.22). Among complications, there were no life-threatening complications. Similar rates of occurrence of pleural effusion (Group S, 2.3% Group M, 2.3%, P=0.96), pneumothorax (Group S, 2.3% Group M, 3.4%, P=0.75), and wound complications (Group S, 1.2% Group M, 0%, P=0.32) were observed in both groups. However, Group M showed less total intravenous rescue analgesic consumption (Group S, 16.5 mg Group M, 13.92 mg, P<0.01).

CONCLUSIONS

Our findings showed no significant increase in the risk of recurrence or major complications with the approach of non-delayed PE repair for all patients aged 5 years and older. Our transition from a single-bar to a multiple-bar repair approach has been crucial for achieving a thorough anatomical remodeling of the entire chest wall. This strategic shift has proven to be a safe and effective surgical method, applicable even to pediatric PE patients.