A new minimally invasive technique for correction of pectus carinatum

Abstract

Background: The Abramson technique for the correction of pectus carinatum (PC) is commonly performed worldwide. However, the postoperative complications of this technique related to bar fixation, including wire breakage and bar displacement, are relatively high. In this study, a new minimally invasive technique for correction of PC is described, in which the pectus bar is secured by bilateral selected ribs, and for which no special fixation to the rib is needed.

Methods: The procedure was performed by placing the pectus bar subcutaneously over the sternum with both ends of the bar passing through the intercostal space of the selected rib at the anterior axillary line. The protruding sternum was depressed by the bar positioned in this 2 intra- and 2 extra-thorax manners. Between October 2011 and September 2019, 42 patients with PC underwent this procedure.

Results: Satisfactory cosmetic results were obtained in all the patients. The mean operation time was 87.14 min, and the mean postoperative stay was 4.05 days. Wound infection occurred in 3 patients, 2 were cured by antibiotics, and 1 received bar removal 4 months after the initial operation due to the exposure of the implant resulting from uncontrolled infection. Mild pneumothorax was found in 3 patients and cured by conservative treatment. One patient suffered from hydropneumothorax, which was treated with chest drainage. The bars were removed at a mean duration of 24.4 months since primary repair in 20 patients without recurrence.

Conclusions: This new technique for minimally invasive correction of PC deformity is a safe and feasible procedure yielding good results and minimal complications.

Keywords: Fixation; Minimally invasive correction; Pectus bar; Pectus carinatum.

Fig. 1

a Preoperative marking of the rib at the anterior axillary line. The upper and lower intercostal spaces were planned to divide. b A polyvinyl chloride tube was pulled out from the upper intercostal space to the lower intercostal space of the rib at the anterior axillary line

Fig. 2

Operative procedures. a A PVC tube was passed through the subcutaneous tunnel from a skin incision to the contralateral incision. b One tip of the pectus bar was inserted into the PVC tube lumen. c The pectus bar was guided to pass through the subcutaneous by the PVC. d The pectus bar was flipped over 180° and advanced into and back out of the chest by passing from the upper intercostal space to the lower intercostal space. PVC: polyvinyl chloride

Fig. 3

The 3-dimensional imaging of a 13-year-old patient’s computed tomography before a and after b the operation

Fig. 4

Symmetric pectus carinatum of a 13-year-old patient before a and after b surgery