Background:
Pectus Excavatum (PEx) and Pectus Carinatum (PCar) are congenital chest deformities traditionally treated with Ravitch procedure or the Nuss procedure. The senior author (ZM) has been treating patients with small-incision sternoplasty (SIS), a technique borrowing principles of Ravitch’s procedure, for the past 9 years. The study aimed to review both surgical and patient reported outcomes (PRO) of the technique.
Methods:
All patients who underwent SIS by the senior author were included in the study. Information regarding patient demographics, operative details, length of stay (LOS) and post operative outcomes were retrospectively collected. A cross-sectional questionnaire assessing PRO using a visual analogue scale (VAS) rating (0-10) pre-operative and post-operative functional and quality of life (QOL) were conducted.
Results:
Between 2012-2021, 65 patients met inclusion criteria with a mean age of 23.29 ±11.09 (range 14-65). The chest deformity corrected were predominantly PEx (87.7%). The mean operative time was 205.06 ±30.28 minutes and mean LOS was 4.22 ±0.89 days. Intraoperative complication rate was 1.5% (pleural tear, all managed conservatively). Post-operative complication rate was 12.3% (3 keloid scars, 6 seromas). Most complications occurred prior to 2015 suggesting a mild learning curve.
Study questionnaire response rate was 64.4% (n=38). Up to 73.7% of these patients encountered social teasing with 15.8% persisting into adulthood. 20 patients reported functional chest symptoms with 17 improving post-operatively. All aspects of PRO related to QOL improvement reached statistical significance (p<0.0001): self-consciousness of deformity (from 7.3 to 3.2); confidence in chest appearance (from 3.0 to 7.6); with an overall surgical experience score of 8.09±1.7.
Conclusion:
The SIS is a procedure that is highly rated by the patients with low complication rates. A significant number of patients with these chest deformity suffered social embarrassment and it appears that SIS is safe and effective at significantly improving the patients’ self-image and confidence.