2008, Number 3
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ABSTRACTIntroduction: Pectus excavatum is the most frequent congenital deformity of the anterior chest wall (90-92%). The remaining is distributed among pectus carinatum, cleft sternum, Cantrell syndrome and Poland syndrome, in order of frequency. Worldwide incidence is 1:300-1:1000 liveborn infants, whereas in Mexico it is 1:1000. Pathogenesis is attributed to an abnormal growth of costal cartilages. Therapeutic management must be adjusted according to each individual case. The aim of this work was to report our experience in the surgical treatment of pectus excavatum.
Material and methods: This was a retrospective, descriptive, observational and longitudinal study carried out in patients with diagnosis of pectus excavatum who underwent surgical treatment at the National Institute of Respiratory Diseases. Basic statistical analysis was made. Surgical techniques used were those of Ravitch, as modified by Welch, and the minimally invasive of Nuss.
Results: Six male patients were found, three of them treated with the Ravitch-Welch technique and three with the Nuss procedure. Median age was 15 years. One patient (17%) presented co-morbidity, and three patients (50%) psychological complaints. Average Haller index was 3.48. No late complications in 14.3 months average follow-up have been observed. Early complication with residual pneumothorax requiring a chest tube was found in two cases. Up to date, no retrosternal bar has been removed in any patient.
Discussion: Application of the Nuss technique to adult patients requires a more intensive management of pain and a better stabilization of the bar than in children, but it is feasible with good results, as long as a suitable control of pain and a correct fixation are achieved, and of course after a not so prolonged learning curve as in the past. However, prospective long term follow-up studies are still required.
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