Surgical repair of pectus excavatum

Pectus excavatum is the most common chest deformity. Children with severe deformities suffer physical complaints such as frequent respiratory infections and decreased endurance. Patients with even mild deformities may complain of physical and psychological symptoms after puberty. In most patients, cardiac and respiratory function deteriorates, meaning that surgical correction is important for alleviation of symptoms and improving cardiopulmonary function and quality of life. The methods of surgical repair remain controversial. The traditional method, first described by Ravitch, comprises resection of deformed cartilages and correction of the sternum by wedge osteotomy in the upper sternal cortex. Ravitch's methods have been modified using autologous or exogenous materials to fix the lower sternum. Nuss reported a novel method in which neither an anterior wound nor the cutting of cartilage or sternum is required; instead, a convex metal bar is placed behind the sternum. We have reported sternocostal elevation, in which a section of costal cartilage is resected, and all of the cartilage stumps are resutured to the sternum. The secured ribs pull the sternum bilaterally, such that the resultant force causes the sternum to rise anteriorly. Because most pectus excavatum patients are young and maintain an acceptable quality of life preoperatively, we believe that the morbidity rate is one of the most important factors in selecting the method for corrective surgery. Repair can be performed safely through the use of skilled techniques and a deep understanding of the anatomy and physiology of the thorax. © 2010 The Japanese Association for Thoracic Surgery.