Modified minimally invasive pectus repair in children, adolescents and adults: an analysis of 262 patients.

In order to achieve safe and successful funnel chest treatment even in older patients and reduce postoperative complications, we modified the procedure of minimally invasive pectus repair using the single-piece pectus bar (PSI Hofer Medical, Austria) with no metal abrasion. The features of modified minimally invasive funnel chest correction (MMIPR) are the following: (a) additional subxiphoidal incision, (b) anterior mediastinal-mediastinoscopic mobilization, (c) mediastinoscopy, (d) elevation of the funnel during pectus bar placement, and (e) fixation of the implant ends in a latissimus dorsi muscle bag, below the anterior margin of the muscle. In older funnel chest patients with a stiff thorax, a curved sternum, marked asymmetry or a mixed pigeon/funnel chest, the minimally invasive correction method has to be supplemented by additional surgical measures (MEMIPR) such as partial sternotomy (23%), slit-rib chondrotomy under thoracoscopic guidance (Rokitansky method; 48%), rib resection (5%), and occasionally rib osteotomy.