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Minimally invasive repair of pectus carinatum by the Abramson method: A systematic review

Published:December 05, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.11.028

      Highlights

      • What is currently known about this topic?
      • Pectus carinatum, the second most common congenital chest wall deformity, is associated with cosmetic complaints for which surgical repair can be indicated. The minimally invasive Abramson method is currently the preferred surgical treatment option for this deformity.
      • What new information is contained in this article?.
      • No systematic review on outcomes of minimally invasive repair of pectus carinatum (MIRPC) by the Abramson method is present in literature. This review provides an overview of the outcomes after MIRPC by the Abramson method to determine its effectiveness, with subjective postoperative esthetic outcomes as primary outcome measure.

      Abstract

      Background

      The aim of this review is to provide an overview of the outcomes after minimally invasive pectus cartinatum repair (MIRPC) by the Abramson method to determine its effectiveness.

      Methods

      The PubMed and Embase databases were systematically searched. Data concerning subjective postoperative esthetic outcomes after initial surgery and bar removal were extracted. In addition, data on recurrence, complications, operative times, blood loss, post-operative pain, length of hospital stay, planned time to bar removal and reasons for early bar removal were extracted. The postoperative esthetic result, was selected as primary outcome since the primary indication for repair in pectus carinatum is of cosmetic nature.

      Results

      Six cohort studies were included based on eligibility criteria, enrolling a total of 396 patients. Qualitative synthesis showed excellent to satisfactory esthetic results in nearly all patients after correctional bar placement (99.5%, n = 183/184). A high satisfaction rate of 91.0% (n = 190/209) was found in patients after bar removal. Recurrence rates were low with an incidence of 3.0% (n = 5/168). The cumulative postoperative complication rate was 26.5% (n = 105/396), of whom 25% required surgical re-intervention. There were no cases of mortality.

      Conclusions

      Minimally invasive repair of pectus carinatum through the Abramson method is effective and safe. Its efficacy is demonstrated by the excellent to satisfactory esthetic results in 99.5% and 91.0% of patients after respectively correctional bar placement and implant removal. Future studies should aim to compare different treatment options for pectus carinatum in order to elucidate the approach of choice for different patient groups.

      Abbreviations:

      PC (Pectus Carinatum), MIRPC (Minimally invasive repair of pectus carinatum), PRISMA (Preferred Reporting Items for systematic reviews and meta-analyses), SD (Standard deviation), NOS (Newcastle-Ottawa scale), VAS (Visual Analogue scale)

      Keywords

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