H Fallouh1; H Naase1; J George1; A Pirtnieks1; M Kornaszewska1;
1 University Hospital of Wales, UK
ObjectiveThe Nuss bar correction has become a cornerstone in the correction of Pectus Excavatum (PE) and possibly the first line surgical option over the modified Ravitch technique. Meanwhile there has been no widely used minimally invasive option for Pectus Carinatum Patients (PC). In Wales, there is high prevalence in PC (up to 35% of pectus deformity patients). Therefore the need to offer a minimally invasive option is desirable. Abramson’s repair has been recently developed using a modified pectus bar in front of the sternum and anchored to the ribs with wire fixation to offer minimally invasive alternative to the modified Ravitch procedure in PC. Thus, we offered this procedure to suitable young patients with chest compliance and we present the early results.
MethodsWe offered this procedures to patients below the age of 25 with the ability to reduce the deformity by compression. So far, we identified 13 patients suitable for the procedure. From July 2015 to November 2016, we performed five patients with pectus carinatum deformity were (4 male and 1 female). The bar was fashioned and tunnelled under the skin. Sternal compression was maintained by anchoring the rib fixators to the ribs using RTI® sternal cable system. Manual pressure was applied on the anterior chest to ensure a good fit during compression.
ResultsPatient's mean age was 19.4±4.6 years. There was a high degree of correction and satisfaction in all patients (Photo). We expect to complete at least 13 patients by March 2017. So far one patient suffered of multiple episodes of rib fixation cable fracture and required cable replacement 3 times. No other complications were reported.
ConclusionEarly data suggests that Abramson procedure could offer a very good minimally invasive and cosmetic alternative to the modified Ravitch repair in PC. Fracture rib fixation cable could be a limitation in this procedures. However, long-term follow-up after bar removal and more case recruitment are required for further validation of this technique.