Retrospective review of reoperative pectus excavatum repairs

• Published in: Journal of pediatric surgery Vol. 45; no. 1; pp. 200 - 205
• Main Authors: Antonoff, Mara B, Saltzman, Daniel A, Hess, Donavon J, Acton, Robert D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2010
• Subjects: Adolescent; Adult; Child; Female; Funnel Chest - surgery; Hospitalization; Humans; Length of Stay; Leonard procedure; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - statistics & numerical data; Nuss procedure; Pectus excavatum; Pediatrics; Postoperative Complications - epidemiology; Ravitch procedure; Reconstructive Surgical Procedures - methods; Reconstructive Surgical Procedures - statistics & numerical data; Recurrence; Reoperation; Reoperation - methods; Reoperation - statistics & numerical data; Retrospective Studies; Surgery; Treatment Outcome; Ravitch procedure; Reoperation; Recurrence; Pectus excavatum; Leonard procedure; Nuss procedure
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2009.10.036

Abstract Background/Purpose Despite success of several techniques described for pectus excavatum repair, a minority of patients require multiple reoperations for recurrence or other complications. We aimed to review our experience in reoperative pectus excavatum repairs and to identify features correlating with need for additional reoperations. Methods Charts were reviewed of all patients undergoing reoperative pectus excavatum repair for 3 years at a university-based children's hospital. Number and type of previous repairs, time between operations, lengths of stay, analgesia, and complications were recorded. Results From February 2004 to December 2007, 170 pectus excavatum repairs were performed. Among these, 27 were reoperative. Overall, 18.2% of reoperative patients required subsequent additional reoperations. 21.1% of patients undergoing repeat open repairs and 33.3% of patients undergoing repeat minimally invasive repairs required further operative interventions. There was no need for additional repairs among patients who had open repairs after minimally invasive repairs, nor for any patients who had minimally invasive repairs after open repairs. Conclusions We conclude that patients with failed open repairs will have better success with minimally invasive reoperations, whereas patients with failed minimally invasive repairs will have better success with open reoperations. When faced with reoperative pectus excavatum, we recommend consideration of an alternative operative approach from the initial procedure.