Minimally invasive repair for pectus excavatum in adults

Background. The purpose of this study is to review the minimally invasive pectus excavatum repair in adults to determine the safety and effectiveness. Methods. An Institutional Review Board approved chart review identified patients 17 years or older who underwent minimally invasive pectus excavatum repair (MIPER) between January 1999 and January 2004. Results. Nineteen patients underwent MIPER. Indications for surgery were reduced exercise tolerance (13), dyspnea on exertion (17), improve self-perception (10), and chest pain (6). There were no intraoperative complications or conversions to open repair. Twelve patients (63%) required one strut and seven patients (37%) required two struts. Postoperative complications included self-resolving asymptomatic pneumothorax in six patients and pneumonia in one. Pain at six weeks postoperatively was mild to none in most patients and all had no pain at three months postoperatively except one patient with strut displacement. Two patients required removal of one of two struts due to displacement. The mean postoperative pectus index was significantly lower than preoperative value: 2.5 versus 4.6, p = 0.002. Among six patients with strut removal at two years postoperatively, two patients had mild recurrence of their deformity. Conclusions. Minimally invasive pectus excavatum repair can be performed safely in adults. This approach is technically more challenging in adults with one-third of the patients requiring two struts for optimal repair. The risk of strut displacement is higher than in the pediatric population. The long-term effectiveness and durability of this procedure in adults is still unknown.