Postoperative outcomes after minimally invasive repair of pectus excavatum in children

Abstract

Objectives: This study aims to evaluate the postoperative outcomes of 18 years of clinical experience in minimally invasive repair of pectus excavatum (MIRPE). Patients and methods: Ninety-four patients (73 males, 21 females; mean age: 12.6±3.7 years; range, 3 to 18 years) who underwent MIRPE between June 2006 and January 2024 and whose metal bars were removed after the treatment period were included in the study. The patient files were retrospectively reviewed in terms of demographic characteristics, clinical findings, radiological findings, and postoperative complications. Results: Preoperative cardiac anomalies were present in 61% of the patients. Two patients had ventricular compression due to deformity. The mean preoperative Haller index was 4.06±1.46. Except for one patient who was placed double metal bars, all patients received a single bar and bilateral stabilizers. The mean operation time was 85±23.5 min. Postoperative complications were observed in 18 (19%) patients. These complications were bar dislocation (n=11, 11.7%), pneumothorax (n=4, 4.3%), wound infection (n=4, 4.3%), postoperative persistent pain (n=4, 4.3%), wound hematoma (n=3, 3.2%), stabilizer dislocation (n=2, 2.1%), intraoperative chest wall bleeding (n=1, 1.1%), allergy (n=1, 1.1%), pericarditis (n=1, 1.1%), bar infection (n=1, 1.1%), and pleural effusion (n=1, 1.1%). Patients with complications had higher Haller index or higher cardiac anomalies compared to patients without complications (p<0.05). The mean time for removal of the metal bar was 26±5.3 months. In two cases, the bar was not replaced after removal due to complications. Seven patients had recurrence after bar removal, six of whom were followed conservatively, and one underwent reoperation. Half of the patients with depression of sternum were among those who had developed complications. The mean follow-up time after bar removal was 50.7±43.4 months. Conclusion: In children, MIRPE can be safely performed with better surgical outcomes and fewer complications.