Pigeon chest: comparative analysis of surgical techniques in minimal access repair of pectus carinatum (MARPC)
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REVIEW ARTICLE
Pigeon chest: comparative analysis of surgical techniques in minimal access repair of pectus carinatum (MARPC) Ancuta Muntean1,2 · Ionica Stoica2 · Amulya K. Saxena1 Received: 6 February 2017 / Revised: 8 February 2017 / Accepted: 17 July 2017 © Children’s Hospital, Zhejiang University School of Medicine 2018
Abstract Background After minimally invasive repair for pectus excavatum (MIRPE), similar procedures for pectus carinatum were developed. This study aimed to analyse the various published techniques of minimal access repair for pectus carinatum (MARPC) and compare the outcomes. Data sources Literature was reviewed on PubMed with the terms “pectus carinatum”, “minimal access repair”, “thoracoscopy” and “children”. Results Twelve MARPC techniques that included 13 articles and 140 patients with mean age 15.46 years met the inclusion criteria. Success rate of corrections was n = 125, about 89% in cumulative reports, with seven articles reporting 100%. The complication rate was 39.28%. Since the pectus bar is placed over the sternum and has a large contact area, skin irritation was the most frequent morbidity (n = 20, 14.28%). However, within the complication group (n = 55), wire breakage (n = 21, 38.18%) and bar displacement (n = 10, 18.18%) were the most frequent complications. Twenty-two (15.71%) patients required a second procedure. Recurrences have been reported in four of twelve techniques. There were no lethal outcomes. Conclusions MARPC techniques are not standardized, as MIRPE are, so comparative analysis is difficult as the only common denominator is minimal access. Surgical morbidity is high in MARPC and affects > 2/3rd patients with about 15% requiring surgery for complication management. Keywords Children · Complications · Minimal access surgery · Pectus carinatum
Introduction Pectus carinatum (PC) or pigeon chest is defined as a continuum of anterior chest wall deformities noted by the protrusion of the sternum and associated convex deformity of the adjacent costal cartilages [1]. It is less common than pectus excavatum (PE) and mainly affects males (4:1) [2]. There are different types depending on the maximum point of the deformity: the chondrogladiolar form is the most common variety (involving the lower sternum) with symmetric or asymmetric protrusion and the chondromanubrial from, * Amulya K. Saxena [email protected] 1
Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London SW109NH, UK
Department of Paediatric Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland
2
which is much less common (involving the upper sternum) [3]. PC was termed by Fonkalsrud “the undertreated deformity” [4], in the present there are three therapeutic options: nonoperative therapy using orthotic bracing and dynamic compression, surgical reconstruction by open technique and minimal access repair [1]. Recommendation for surgical correction remains controversial becau
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