Orthotic Bracing or Minimally Invasive Surgery? A Summary of 767 Pectus Carinatum Cases for 9 Years

Abstract

Orthotic bracing and minimally invasive surgery are currently the treatment methods for pectus carinatum. We present our experience with the advantages, method selection criteria, and precautions for both treatment methods. A total of 767 pediatric patients (596 boys and 171 girls) with pectus carinatum were retrospectively analyzed. All of them received orthotic bracing, and 108 pediatric patients received minimally invasive surgery, achieving good outcomes. Among the 767 pediatric patients, 644 obtained satisfactory chest appearance through orthotic bracing, with a success rate of 84.0%. Younger pediatric patients had better orthotic outcomes. Among the 123 failure cases, 108 pediatric patients underwent minimally invasive surgery as the treatment. Seventy-six pediatric patients with simple chondrogladiolar prominence underwent a minimally invasive sternal depression procedure, whereas 32 pediatric patients with complex chondromanubrial prominence underwent surgery. All 108 pediatric patients successfully completed the surgery. The operation time was 112.8 ± 23.5 min, and the average length of hospital stay after the surgery was 7 days. A follow-up was conducted for at least 3 months and up to 3 years. The orthotic effect was satisfactory. For younger pediatric patients with pectus carinatum, noninvasive orthotic bracing treatment should be considered first. For older pediatric patients, the failure rate of the bracing was higher, and the outcomes were often unsatisfactory. Especially for patients over 15 years old, minimally invasive sternal depression may be the preferred treatment for pectus carinatum.

Bracing of Pectus Carinatum in Children: Current Practices

“…Like PE, PC has a tendency of progressive aggravation with age. Thus, once the diagnosis is confirmed, patients should be actively treated [23], or at least carefully monitored. In the last two decades, the treatment of PC has seen a gradual shift away from surgical treatment (open correction and mini-invasive correction) to a non-surgical approach.…”

“…Many authors have already published their results. For comparison, de Beer et al in a meta-analytic study, processed the results of 8 single-center studies, including 1185 patients [26]; the largest single-center studies analyzed 740 and 664 patients, respectively [23,27].…”

“…"Pectus posture" refers to the position caused by the forward displacement of the patient's shoulders and the development of thoracic kyphosis [28]. Abnormal posture and lack of back muscles training may worsen the deformity [23]. Even if long-term evidence of effectiveness is lacking, physical therapy for treating PC and posture is an important and often poorly recognized treatment option [19,28].…”

The Role of Anthropologic Measurements in Pectus Carinatum Brace Treatment Evaluation

“…Although the positive effect of the compressive bracing in PC treatment has been proven for years, there are still no uniform criteria regarding the selection of patients for conservative treatment, the daily duration of wearing the device, the total duration of the therapy and long-term outcomes after the treatment [13], [14]. Better and faster results are seen in younger patients older age and an asymmetrical configuration of the anterior chest wall are factors that can lead to a treatment failure [16], [24]. In contrast, our experience has not confirmed the differences between the treatment success in patients with symmetric and asymmetric deformity.…”

“…In the last two decades, a gradual shift from different types of surgical correction to a non-operative solution has been observed [14]. Nowadays, the compressive brace treatment of flexible PC is progressively becoming the first-line treatment option [15], [16]. Based on several years of experience in many specialized centres, it can be said that it is an effective method, with confirmed favourable therapeutic results, not requiring any surgical procedure and anaesthesia, and thus eliminating the potential risks associated therewith.…”