Use of a subxiphoid incision for pectus bar placement in the repair of pectus excavatum

Abstract

Background Since the first description of the Nuss repair for pectus excavatum, many technical variations have been described. Over the past 10 years, we have used a subxiphoid incision to allow finger guidance to protect the mediastinum which obviates the need for thoracoscopy. Methods A retrospective review was conducted on all our patients who have undergone pectus excavatum repair from December 1999 to March 2009. Demographic, treatment, and outcome variables were recorded. All operations were performed with 2 lateral incisions, one subxiphoid incision, and 2 stabilizers. Results During this timeframe, 307 patients underwent pectus bar placement. Mean age was 14.0 ± 3.3 years, and 78% were male. Mean operating time was 50.0 ± 15.9 minutes, length of hospitalization was 4.1 ± 1.1 days, and time to bar removal was 33.0 ± 7.3 months. There were no intraoperative events. Postoperative complications included a bar infection in 13 patients (4.2%), stabilizer displacement/discomfort requiring removal in 5 patients (1.6%), and bar rotation in 4 patients (1.3%). Rotation required operative correction in 3 cases and early removal in the other owing to a cracked sternum. No reoperations have been done for recurrence. Conclusions The subxiphoid guided technique is a simple, safe, and reproducible method for the minimally invasive repair of pectus excavatum that obviates the need for thoracoscopy.