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Eric W. Fonkalsrud, MD; Julianne Mendoza, MD; Paul J. Finn, MD; Christopher B. Cooper, MD

Arch Surg. 2006;141:823-829.

Hypothesis  Inconsistent results have been reported using a variety of open surgical techniques to correct pectus excavatum (PE) deformities with subperiosteal resection of deformed costal cartilages.

Design  Retrospective 6-year review of 450 consecutive patients undergoing PE repair.

Setting  Tertiary care academic medical center.

Patients  Symptomatic patients with severe PE (severity index >3.4).

Intervention  Evaluation of open repair with minimal cartilage resection, suture reattachment of costal cartilages to the sternum and ribs, and internal support strut for 6 months.

Main Outcome Measures  Age at repair, severity index, reduction of symptoms, complications, recurrence, and mortality.

Results  Nine percent of patients were younger than 12 years at repair, 42% were aged 12 to 17 years, 33% were aged 18 to 30 years, and 16% were older than 30 years. Nineteen percent were female. Mean ± SD severity index was 4.88 ± 1.8. Mean hospital stay was 2.9 days. No patients received epidural analgesics. Complications occurred in 2.6% of patients and included idiopathic ventricular arrhythmia (2 patients), transient pericarditis (2 patients), pleural effusion (3 patients), dislodged sternal bar (2 patients), hematoma (1 patient), seroma (1 patient), and localized infection (1 patient). Mild recurrence occurred in 4 patients, and 9 patients had resection of localized cartilage protrusion when the bar was removed. There were no deaths. Ninety-eight percent of patients reported very good to excellent results. All patients reported improvement in symptoms. Mean follow-up was 26 months after strut removal.

Conclusion  In this largest, to our knowledge, recently reported series of openly repaired PE using minimal cartilage resection and suture reattachment of the costal cartilages to the sternum and ribs, advantages included short operative time, stable early postoperative chest wall, few complications, mild pain, good physiologic and cosmetic results, and effectiveness for all variations of PE in patients of all ages.

Author Affiliations: Departments of Surgery, Medicine, and Radiological Sciences, University of California, Los Angeles Medical Center, Los Angeles.