Pectus Excavatum
Pectus excavatum is the most common congenital deformity of the chest wall. Boys are affected much more frequently than girls, and a genetic predisposition is also observed. (2)
The severity and symmetry of pectus excavatum can vary greatly. However, the condition often worsens with growth during puberty. (1,2) While mild forms often do not cause physical symptoms, more severe cases can lead to limitations in physical endurance or back pain due to resulting poor posture. (1-4) In addition to these physical symptoms, the psychological aspects are also of particular importance. Especially during puberty, there is a decrease in self-esteem. Therefore, social activities are often avoided. This represents a significant psychological burden for those affected and their relatives, and is one of the main reasons for deciding to correct pectus excavatum. (5)
Treatment of Pectus Excavatum
Various methods are available for treatment, all of which emphasize the importance of accompanying physiotherapy. In mild cases, daily use of a vacuum bell can improve the indentation. This can be a sensible initial therapy, especially for children. (2) Asymptomatic deformities can be aesthetically corrected with silicone implants. (6)
The minimally invasive Nuss procedure (MIRPE) has now become the gold standard for surgical treatment. (1,2,8) Although this is a relatively safe procedure, the rare complications can have serious consequences. (1,6,8) To improve safety, the original approach has been supplemented with additional procedures. Various elevation techniques, such as the intraoperative use of the vacuum bell or the attachment of hooks to the sternum, can facilitate penetration of the mediastinum, especially in severe cases, and reduce the risk of injury to mediastinal structures. The surgery should also be performed under continuous thoracoscopic control to enable a targeted and safer approach. (6)
Adult Pectus Excavatum
The question of the right timing for surgery is constantly discussed. This is mainly due to the fact that cartilage ossifies with age, and the thorax is stiffer in adults than in children and adolescents. Accordingly, MIRPE was initially indicated for children and adolescents. (1) Increasing studies show, however, that good to very good results can also be achieved in adults. (7,8) This usually requires the insertion of more than one bar (cross-bar method) to stabilize the greater resistance of the thorax. Overall, however, adults show a higher incidence of postoperative complications such as pneumothorax, pleural effusion, wound infection, and bar dislocations, up to the need for revision. (6) Some publications suggest that the semi-open MOVARPE method may lead to even better correction results in adults. (8)
To avoid surgical complications, it is advisable to treat pectus excavatum early. An age range of about 13-16 years has proven effective for performing MIRPE. (1) By intervening before growth is complete, poor posture can be avoided, and sufficient space is available for the physiological functions of the heart and lungs. This may improve growth, which is sometimes restricted as a result. (6) It is also particularly important that this promotes mental well-being and timely intervention contributes to the normal psychological development of children. (5,6)