Repair of Recurrent Pectus Deformities

A paucity of information is available regarding the surgical repair of recurrent pectus deformities (RPD). From 1993 through 2001 35 patients ranging in age from 6 to 51 years (mean, 23 years) underwent repair of RPD a mean of 11 years after the original repair: modified Ravitch repair (31), prosthetic implantation (three), and Nuss procedure (one). All patients had accompanying symptoms including decreased stamina (76%), chest discomfort (53%), asthma (33%). The repair performed was dependent on the findings at operation. A modified Ravitch procedure with Adkins strut was performed for 21 patients. Three had reattachment of mobile costal cartilages and/or xiphoid process to the sternum; three patients had autologous bone or cartilage grafts, three had muscular reconstruction, and two had resection of a localized cartilage protrusion. Three patients could not be reconstructed safely. Very good to excellent results were achieved for 32 patients (mean follow-up, 24.8 months). There were no deaths or major complications. Minor complications occurred in five patients. The mean blood loss was 105 mL. The mean hospital stay was 2.8 days. We conclude that although it is technically difficult RPD can be repaired with low morbidity, short hospital stay, and very good physiologic and cosmetic results.