Minimally invasive repair of pectus excavatum in an adolescent with a history of a median sternotomy as an infant

Abstract

The report by Nuss et al., in 1998 of their 10-year experience with minimally invasive repair of pectus excavatum introduced the possibility of a less invasive approach for the correction of chest wall abnormalities. This procedure is now well-accepted around the world, although serious complications such as intraoperative cardiac perforation and postoperative bar displacement have been reported. The Nuss procedure has been performed concurrently with sternotomy for cardiac operations. However, there have been no reports of minimally invasive pectus excavatum correction in a child with a remote history of a median sternotomy. With IRB approval (Protocol #1308002283) we report the successful completion of a Nuss procedure in an adolescent with a history of a median sternotomy in infancy. During the procedure, thoracoscopy on the right side revealed significant adhesions of the lung and pericardium to the posterior sternum. Additional trocars were placed bilaterally to facilitate visualization and to allow for lysis of the adhesions with bipolar cautery. Passage of the bar was accomplished uneventfully and the patient has an excellent cosmetic outcome 28 months following the operation. We believe that a previous median sternotomy should not be viewed as a contraindication to the minimally invasive repair of pectus excavatum. • This article describes the minimally invasive repair of pectus excavatum in an adolescent who had undergone a previous sternotomy as an infant, something not previously described in the literature. • The preoperative work-up and steps in preparing for the operation are discussed in detail. • Although challenging and requiring additional maneuvers, the operation was completed successfully and without complication. • Our conclusion is that this is a reasonable approach to consider in this unusual group of patients, provided that certain precautions are taken.