Minimally invasive correction of pectus excavatum

Pectus excavatum is a relatively common congenital birth defect, occurring in as many as 1 of 400 children. Sometimes considered a mere cosmetic problem, pectus excavatum can dramatically worsen during puberty, resulting in compression of the lungs and shifting of the heart to the left. Correcting the problem in adulthood, when lung and heart function may become more severely impaired, usually requires open surgery.

At Mayo Clinic's campus in Rochester, Minnesota, pectus excavatum is treated with minimally invasive surgery during adolescence. The 45-minute procedure involves inserting metal bars through small incisions on the sides of the chest to lift the chest wall to a normal position.

"Like scoliosis patients, children with pectus excavatum have the best results if they are braced during their rapid growth years," says Christopher Moir, M.D., a pediatric surgeon at Mayo Clinic. "The body then has a chance, while it is still very flexible, to remodel around the brace. If you wait until the child finishes growing, the deformity sets in that position and is difficult to correct."

The brace usually remains in place until the patient has finished growing. Males, who are four times likelier than females to have pectus excavatum, may not reach that point until their early 20s. However, the brace doesn't limit activities. "Our patients don't feel the bars. They can do every sport," Dr. Moir says.

Timely and efficient correction

Most cases of pectus excavatum appear to be minimal or even invisible before puberty. Although correction shouldn't be done before the rapid growth years of puberty, it is helpful to diagnose the condition before then.

"We like to identify these patients by age 10 or 11, watch them carefully and then do surgery sometime around ages 12 to 14," Dr. Moir says. "If we see patients at age 16 or 17, we can still do the repair, but it is much more difficult."

When evaluating children for pectus excavatum, Mayo Clinic specialists generally avoid using CT scan, which irradiates the thyroid and mediastinum. "We can tell from a chest X-ray, physical exam and pulmonary function test whether the patient needs surgery," Dr. Moir says. "It's a thorough but cost-effective work-up, and we spare the kids from needless radiation exposure."

Hundreds of minimally invasive pectus surgeries have been done at Mayo Clinic since it became one of the first centers in the U.S. to offer the procedure. Mayo specialists have developed a postoperative pain-control protocol that results in hospital stays of just three to four days after surgery for most patients. "Our patients' average pain scores are 2 or 3 out of 10," Dr. Moir says.

Follow-up care can be coordinated with the patient's home physician. Online appointments are an option, and X-rays can be taken at home and sent to Mayo Clinic.

"Correcting pectus excavatum used to require an operation lasting six to eight hours," Dr. Moir says. "Ours is a very minimally invasive, well-established practice. We have a high success rate and very few if any major complications from the procedure."