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PECTUS UP TECHNIQUE: EXTRATHORACIC SURGICAL CORRECTION FOR PECTUS EXCAVATUM

This technique has represented an important technological innovation in the field of thoracic surgery for the treatment of this pathology, since it is an extrathoracic method that considerably reduces the complexity and risks of the intervention. Recovery time is shorter and patients treated with this new technique highlight the low presence of pain and the quick return to normal life.

INFORMATION ABOUT PECTUS EXCAVATUM

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Pectus Excavatum is the most frequent congenital deformity of the chest cavity, characterized by a concave depression of the sternum, better known as funnel chest. Without a doubt, the hallmark of Pectus Excavatum is the sunken appearance of the sternum.
It is a progressive disease that may be visible from birth, but usually becomes more evident as years go by.

Pectus Excavatum may become evident in different degrees of affectation. There are patients with a mild deformity, practically asymptomatic, but with aesthetic implications, as well as patients with a moderate or severe affectation, who suffer from important physical problems and socio-psychological alterations.

This pathology usually appears in early childhood and when it is severe, it can have serious effects on the patient, since the bone deformation can end up causing lung problems, making breathing difficult and causing other respiratory symptoms. Heart problems can also occur, leading to a lack of adaptation to physical activity. Another common condition is a bad position of the spine which, in some cases, comes as an actual curvature or scoliosis.

Besides, the patient with Pectus Excavatum may suffer from psychological affections that may lead to a tendency to isolation and loneliness, which may become very relevant. The appearance that this pathology confers to the patients’ chest may greatly condition their quality of life, making it difficult to play sports or recreational activities, and even causing self-esteem problems, especially among teenagers.

The pediatrician or family doctor is usually the first physician asked by patients to request information about Pectus Excavatum. If the patient is under 8 years old and asymptomatic, additional tests and surgery are not usually performed. From this age on, it is important to do an annual check-up and see if the defect is progressive. If the defect increases or symptoms related to Pectus Excavatum appear, it should be assessed by a pediatric or thoracic surgeon, in order to receive the best treatment for each particular Pectus Excavatum case.

Many of the people affected by this pathology lead a totally normal life, without any kind of physical or psychological affectation. However, since it is a pathology that tends to be exacerbated with age, it is very important to have an early assessment by a surgeon so that the deformity does not compromise the organs of the thoracic cavity or there is no significant psychological affectation.

Spontaneous regression or any partial improvement of Pectus Excavatum symptoms is uncommon.

SURGICAL TREATMENT OF PECTUS EXCAVATUM

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Surgical techniques evolve, new modifications are introduced and new innovative procedures appear.

Currently there are several techniques for the treatment of Pectus Excavatum, both surgical and non-surgical.

The traditional techniques used in the surgical approach of Pectus Excavatum are invasive and they enter the thoracic cavity to correct the malformation, with the risks this may entail.

Nowadays there is a new treatment for Pectus Excavatum, the surgical method called Pectus Up, which gives the opportunity to correct this pathology in a minimally invasive way and avoiding intrathoracic surgery, as it is the case of the previous surgical techniques.

THE PECTUS UP

The new technique ―Pectus Up― consists of placing an implant on top of the sternum, through a small incision in the chest, which pulls it upwards until a more anatomically correct position is achieved. Afterwards, the implant is fixed to the sternum and to the costal cartilages to maintain that position after the operation.

Prevention of intrathoracic surgery

The new procedure allows the sternum to be raised without the need to insert steel bars into the chest cavity or to remove part of the ribs to reduce the sternum sinking.

As it is an extrathoracic procedure, it is very painless, it involves a short convalescence period and it is free of serious complications.

The implant is removed after 3-4 years, although it can remain in the chest for much longer. The procedure is very simple and without risks.

The Pectus Up opens new perspectives in the surgical treatment of Pectus Excavatum, both for patients, since the age range to be operated on is extended, and for surgeons, since the surgical process has a low complexity.

SUMMARY OF THE BENEFITS OF THE SURGICAL TREATMENT OF PECTUS EXCAVATUM WITH THE NEW PECTUS UP TECHNIQUE

  • Minimally invasive. A small incision is made to place the implant.
  • Reduced risk of damage to vital organs of the chest. It is an extra-thoracic method, so risks are reduced and complications are minimized.
  • Rapid incorporation into daily life. The operation is painless and requires little recovery time.
  • Adaptation to growth. The implant is fixed on the external part of the sternum, which allows a normal development of the thoracic cage without the need to modify or remove the implant.
  • Low duration of surgery. The complexity of the surgical procedure is minimal.
  • Postoperative in intermediate care.  The method is very minimally invasive and the patient usually does not require care in the ICU.
  • Possibility for cardio-respiratory resuscitation. In the case of cardiac failure, these maneuvers can be performed.