Ten-year experience with staged management of pectus carinatum: Results and lessons learned

Kelly Robert Edward; Obermeyer Robert John; Goretsky Michael Jay; Kuhn Marcia Ann; McGuire Margaret Mary; Duke Duane Stopp; Pallera Haree Khrisna; Frantz Frazier Woodrow

doi:10.1016/j.jpedsurg.2021.01.027

Ten-year experience with staged management of pectus carinatum: Results and lessons learned

J Pediatr Surg. 2021 Oct;56(10):1835-1840. doi: 10.1016/j.jpedsurg.2021.01.027. Epub 2021 Jan 27.

Authors

Kelly Robert Edward¹, Obermeyer Robert John², Goretsky Michael Jay², Kuhn Marcia Ann², McGuire Margaret Mary², Duke Duane Stopp², Pallera Haree Khrisna³, Frantz Frazier Woodrow²

Affiliations

¹ Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School. Electronic address: Robert.Kelly@chkd.org.
² Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School.
³ Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA.

PMID: 33558070
DOI: 10.1016/j.jpedsurg.2021.01.027

Abstract

Introduction: We report pectus carinatum management over a 10+year period.

Methods: Staged management, with initial bracing and operation for failure or special circumstances, was employed. A newer brace and a minimally invasive operation for PC (the Abramson procedure) were introduced during the study period.

Results: Of 695 consenting patients from 2008 to 2018, 265 (38%) were observed. Of 430 treated, 339 (79%) had bracing only; 65 (15%) underwent surgery without a trial of bracing, while 26(5%) underwent surgery after a failed attempt at bracing. Of 364 bracing patients, 144 (40%) were successful, 77 (21%) are ongoing, 25 (7%) failed, and 118 (32%) dropped out. Recurrence was noted in 17 (5%), an average 5.4 months later. Two (0.4%) overcorrected to pectus excavatum (PE). Successful patients experienced a 50% decrease in pressure of correction (POC) beginning one month after starting treatment. Brace failure patients did not. Reported compliance with brace utilization (hours/day) was similar. Surgery was required in 91 patients. Open operations were performed in 61 (67%), Abramson operations in 23 (25%), and Nuss procedure in 7 (8%) who developed excavatum over correction following bracing or who had mixed deformity, with excavatum one side of the sternum and carinatum on the other. Twenty-four (36%) of the surgeries for PC occurred after an attempt at bracing. All obtained good initial results by operation. No recurrence was noted after open operation and 3 (13%) after Abramson. Open complications included 1 (2%) infection. Abramson's operation required 11 (48%) revisions, 6 (26%) early bar removals, and had 3 (13%) infections.

Conclusion: Brace treatment for PC can be guided by pressure of correction, which fell by more than half in successfully treated patients. POC did not fall in patients who failed. If POC does not fall, surgery should be considered. Open repair of Pectus Carinatum is generally successful, while the Abramson operation has a significant rate of complications with the implants currently available in the U.S.

Levels of evidence: Level III - Retrospective comparative study.

Keywords: Abramson operation; Brace treatment; Currarino silverman syndrome; Pectus arcutum; Pectus carinatum; Surgical treatment.

MeSH terms

Funnel Chest*
Humans
Pectus Carinatum* / surgery
Retrospective Studies
Sternum / surgery
Treatment Outcome