Modified Pectus Up and the Portuguese Case Series

Abstract

Introduction: Pectus excavatum (PE) is the most common congenital chest wall deformity, with an incidence of 1 in 400 births. Surgical approaches vary depending on the severity of the condition. Recently, the taulinoplasty approach - "Pectus Up®" - was described as an alternative to lift the sternum through external traction, avoiding invading the mediastinum or pleural cavity. We describe our progressively modified taulinoplasty technique and case series.

Materials and Methods: From 2022 to 2024, 13 consecutive patients with pectus excavatum underwent surgical correction with a modified taulinoplasty (Pectus Up®) technique. Demographics, clinical characteristics, preoperative cardiorespiratory data and surgical outcomes were evaluated. The modifications introduced to the technique include preoperative stainless steel skin reaction testing, vertical skin incision, 3D-printed surgical guide and a partial chondrotomy of the costal cartilages involved in the deformity.

Results: The average interference of the pectus excavatum in the quality of life was 7,2 (Likert scale of 0 to 10) and the most common symptom was fatigue on exertion (30,8%). No perioperative complications and no mortality were observed, and 84,6% of patients were discharged on second post-operative day. During a median follow-up of 20 months, there was one case of metal bar allergy requiring oral corticoid therapy, and one case of infection with suture dehiscence requiring oral antibiotic therapy, surgical debridement and negative pressure therapy. In both cases, the pectus bar was not removed. The average pain in the first year after surgery and aesthetic satisfaction were 3,7 and 8,6, respectively (scale 0 to 10).

Conclusion: The implemented modifications result in a more "standardized" technique, which has been providing consistent and reproducible outcomes. This technique seems to be a valid therapeutic option for well selected patients.