Contemporary management of recurrent pectus excavatum

Pectus Updates and Special Considerations in Marfan Syndrome

“…An open operation is often considered after a previous failed procedure; however, the current literature has demonstrated that a Nuss procedure can also be successful in treating recurrence following both minimally invasive and open repair. 40 When overcorrection of a pectus excavatum results in a pectus carinatum deformity, 41 a hybrid procedure can be undertaken with a minimal access modified Ravitch procedure followed by bracing.…”

A Review of Current Treatment Trends in Pediatric Chest Wall Abnormalities

“…New studies have documented the efficacy of the minimal invasive repairs for even recurrent pectus after previous open or minimally invasive procedure [11]. Results of repeat Nuss procedure are good, without increase in the most common complications, of pain and pneumothorax.…”

“…However, a patient is not a candidate for repeat minimally invasive repair if the thoracic deformity is extensive as in acquired Jeune's syndrome. Repair of these patients requires either complete anterior chest wall reconstruction or a modified Ravitch procedure [7,11].…”

“…This is then stabilized with a strut in the retrosternal plane [6]. Recurrence after primary open repair ranges between 2-37% [11]. Outcomes are excellent, disadvantages mainly a centrally located large scar.…”

“…Nuss Procedure is a minimally invasive technique that may be use safely in initial or recurrent pectus excavatum. After failed Nuss or failed Ravitch procedure without any anatomic issues, a modified Nuss is still preferred, with recurrence of deformity after Nuss of about 1.4% [11]. This involves using a videothoracoscope placed into right chest for visualization, and creation of a subcutaneous tunnel in the anterior chest wall at the level of maximum depression, by introducing a large clamp through small incisions in the midaxillary line bilaterally.…”