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Minimally Invasive Repair of Chest Wall Deformities

Common deformities of the anterior chest wall include (1) pectus excavatum, commonly called ‘sunken’ chest, and (2) pectus carinatum, commonly called ‘pigeon’ chest. These deformities can cause functional impairment to the cardiovascular and respiratory system as well as restriction to intra-thoracic organ growth. These chest wall defects may sometimes cause psychological impairment and occasionally associated with poor self-perception, leading to social withdrawal.

The conventional treatment for pectus deformities has been open corrective surgery. However, the operation is not popular with patients and surgeons as it often involves complex invasive surgery with large incisions, significant blood loss, perioperative pain, prolonged hospital stay and scars. A new surgical method to treat these deformities was introduced by Dr. Donald Nuss in 1997 and has now been accepted as the treatment method of choice. This minimally invasive repair of pectus excavatum (MIRPE) involves a minimally invasive surgical approach that inserts a customized stainless steel bracing bar into the chest cavity to brace and remodel the anterior chest wall. As it is done in true minimally invasive fashion, the benefits include small incisions with less pain, increased safety, low complication risk, short procedure time and hospital stay and superior cosmetic effect. The bar is left in place for 2-3 years (in children) or 3-5 years (in adults). The bar can be removed in a simple outpatient procedure. The procedure yields excellent results.

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Diagram of Minimally Invasive Repair of Pectus Excavatum (MIRPE)

X-rays demonstrating the bar in position Left: frontal view Right: lateral view

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Pictures below: pectus excavatum left: before MIRPE Right: after MIRPE

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IJN became the first centre in ASEAN to perform minimally invasive repair of pectus excavatum in 2008. Since then, we have performed 40 minimally invasive repairs of pectus excavatum and in November 2011 we performed the first minimally repair of pectus carinatum. All these procedures were successful with no major complications and have led to improvement of patient’s functional capacity as well as yielded high patient satisfaction. These minimally invasive procedures are recommended for both children and adults with pectus deformities.


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