Early experience of minimally invasive repair of pectus excavatum in RIPAS Hospital

Introduction: Pectus excavatum (PE) commonly known as sunken chest or funnel chest, is a congenital deformity of the anterior chest wall and is the commonest of all congenital chest wall abnormalities. It can be associated with physical and psychological morbidity. This study evaluates our unit’s experience in performing minimally invasive repair of PE (MIRPE) surgery, also known as “NUSS repair” in teenage patients with PE in RIPAS Hospital. Materials and Methods: Retrospective data analysis of the first seven cases of MIRPE performed at RIPAS Hospital since November 2011, when our MIRPE service was first introduced. Patients’ demographic and operative records of all the cases were retrieved from the Department of Surgery Operation Note database and medical notes. Results: There were five males and one female with a mean age of 17 2.3 years (14.6 – 20.7 years) at the time of repair. The mean Haller index, left ventricular ejection fraction, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were 7.0 4.2, 68 6.3%, 3.0 1.3 L/sec and 3.6 1.4 L respectively. Six procedures were performed as a primary procedure and one redo for bar displacement exactly four months after the primary procedure. One patient with the highest Haller index of 15.33 required two bars to correct the defect. The mean duration of procedure was 139.6 57.1 min, with improvement in time in the last two cases down to an average of 86.5 min. Pectus bar used consisted of three Park’s pectus bar and three Biomet pectus bar. There was one early post-operative complication (wound haematoma) and one late complication (bar displacement) which occurred in the same patient. There was no mortality. All patients were satisfied with their outcomes. Conclusion: Our early experience with MIRPE procedure has been satisfactory and with improvement in learning skills, our time for the procedure has come down to under 1.5 hrs.